SPECIAL TESTS

Shoulder

Tests for Anterior Shoulder Instability

1. Load and Shift Tests

Pt. sits w/ no back support & w/ the hand of the test arm resting on the thigh. The examiner stabilized the shoulder w/ one hand over the clavicle & scapula. The other hand grasps the head of the humerus w/ the thumb over the post. Humeral head & the fingers over the ant. Humeral head. The humerus is then gently pushed anteriorly or posteriorly

2. Apprehension ( Crank Test )

for ant. Dislocation The examiner abducts the arm to 90˚ &

laterally rotates the pt’s shoulder slowly . By placing a hand under the GH jt. to act as a fulcrum. Applying a mild anteriorly directed force to the post. Humeral head when in the test position to see if apprehension or pain ↑.

If post. Pain ↑, indicates POST. INTERNAL IMPINGEMENT.

- If post. Superior internal impingement is suspected, relocation test should be done in 110˚ & 120˚ of abduction.

+ test : is indicated when the pt. looks or feels apprehensive or alarmed and resists further motion.

Fowler Sign or Jobe Relocation Test

3. Rockwood Test for ant. Instability The examiner laterally rotates the

shoulder. The arm is abducted to 45˚, and passive lateral rotation is repeated. Same procedure is repeated at 90˚ & 120˚

+ test: show marked apprehension w/ post. Pain when the arm is tested at 90˚. At 45˚ & 120˚, the pt. shows some uneasiness & some pain; at 0˚, there is rarely apprehension.

4. Rowe Test

For ant. Instability Pt. lies supine & places the hand behind

the head. The examiner places one hand (clenched fist) against the post. Humeral head & pushes up while extending the arm slightly.

+ test: apprehension or pain. If a clunk or grinding sound may indicate

a torn ANTERIOR LABRUM.

5. Prone Anterior Instability Test

Prone. The examiner abducts the pt’s arm to 90˚ and laterally rotates it 90˚. While holding this position w/ one hand at the elbow, the examiner places the other hand over the humeral head and pushes it forward.

+ test: reproduction of pt’s symptoms

6. Andrew’s Ant. Instability Test

Supine w/ sh. Abducted 130˚ and laterally rotated 90˚. The examiner stabilizes the elbow and distal humerus w/ one hand & uses the other hand to grasp the humeral head & lift it forward.

+ test: reproduction of pt’s symptoms

7. Ant. Drawer Test of the Shoulder Supine. The examiner places the hand of the affected

shoulder in the examiner’s axilla, holding the pt’s hand w/ the arm so that the pt. remains relaxed. The sh. To be tested is abducted bet. 80˚ & 120˚, forward flexed up to 20˚, and laterally rotated up to 30˚. The examiner then stabilizes the pt’s scapula w/ the opposite hand, pushing the spine of the scapula forward w/ the index and middle fingers. The examiner’s thumb exerts counterpressure on the pt’s coracoid process. Using the arm that is holdingthe pt’s hand, the examiner places his or her hand around the pt’s relaxed upper arm & draws the humerus forward.

+ test: indicates ant. Instabilty depending on the amount of ant. Translation.

8. Protzman Test For ant. Instability Sitting. The examiner abducts the pt’s arm to 90˚

& supports the arm against the examiner’s hip so that the pt’s sh. Muscles relaxed. The examiner palpates the ant. Aspect of the head of the humerus w/ the fingers of one hand deep in the pt’s axilla while the fingers of the other hand are placed over the post. Aspect of the humeral head. The examiner then pushes the humeral head anteriorly & posteriorly.

+ test: if this mov’t causes pain & if palpation indicates abnormal anteroinferior mov’t.

9. Anterior Instability Test ( Lefferts Test )

Sitting. The examiner places his/ her near hand over the sh. So that the index finger is over the head of the humerus anteriorly & the middle finger is over the coracoid process. The thumb is placed over the post. Humeral head. The examiner’s other hand grasps the pt’s wrist & carefully abducts & laterally rotates the arm.

+ test: if, on mov’t of the arm, the finger palpating the ant. Humeral head moves forward.

10. Dugas’ Test

Used if an unreduced ant. Sh. Dislocation is suspected.

The pt. is asked to place the hand on the opposite sh. & then attempt to lower the elbow to the chest.

With an ant. Dislocation, this is not possible, and pain in the shoulder results.

Tests for Posterior Shoulder Instability

1. Load and Shift Test

Described under anterior shoulder instability.

2. Posterior Apprehension or Stress Test

Supine or sitting. The examiners elevates the pt’s shoulder in the plane of the scapula to 90˚ while stabilizing the scapula w/ the other hand then applies a post. Force on the pt’s elbow. While applying axial load, the examiner horizontally adducts and medially rotates the arm.

+ test: apprehension

3. Norwood Stress Test Supine w/ sh. Abducted 60˚ to 100˚ and

laterally rotated 90˚ & w/ the elbow flexed to 90˚ so that the arm is horizontal. The examiner stabilizes the upper limb by holding the FA and elbow at the elbow or wrist. The examiners then brings the arm into horizontal adduction to the forward flexed position. The examiners feels the humeral head slide posteriorly w/ the fingers.

+ test: if the humeral head slips posteriorly relative to the glenoid

4. Push-Pull Test

Supine. The examiner holds the pt’s arm at the wrist, abduct’s the arm 90˚, & forward flexes it 30˚. The examiner places the other hand over the humerus close to the humeral head. The examiner then pulls up on the arm at the wrist while pushing down on the humerus w/ the other hand.

+ test: if more than 50% posterior translation occurs or if the pt. becomes apprehensive or pain results.

5. Posterior Drawer Test of the Shoulder

Supine. The examiner grasps the pt’s proximal FA w/ one hand, flexing the pt’s elbow to 120˚ and the shoulder bet. 20 ˚& 120˚ of abduction & bet. 20˚ & 30˚ of forward flexion. With the other hand, the examiner stabilizes the scapula by placing the index & middle fingers on the spine of the scapula and the thumb on the coracoid process. The examiner then rotates the upper arm medially & forward flexes the sh. To bet. 60˚ & 80˚ while taking the thumb of the other hand off the coracoid process & pushing the head of the humerus posteriorly. The head of the humerus can be felt by the index finger of the same hand.

+ test: pain free, but the pt. may exhibit apprehension.

6. Miniaci Test for Posterior Subluxation

Supine w/ the sh. Off the edge of the examining table. The examiner uses one hand to flex ( 70 to 90 ), adduct, & medially rotate the arm while pushing the humerus posteriorly. With the other hand, the examiner palpates the ant. & post. Shoulder. The examiner then abducts & laterally rotates the arm.

+ test: a clunk will be heard, & the humerus reduces (relocates).

7. Jerk Test Sitting w/ the arm medially rotated & rotated

forward flexed to 90˚. The examiner grasps the pt’s elbow & axially loads the humerus in a proximal direction. While maintaining the axial loading, the examiner moves the arm horizontally ( cross-flexion/ horizontal adduction) across the body.

+ test: sudden jerk or clunk as the humeral head slides off ( subluxes ) the back of glenoid

8. Circumduction Test

Standing. The examiner stands behind the pt. grasping the pt’s FA w/ the hand. The examiner begins circumduction by extending the pt’s arm while maintaining slight abduction.

+ test: if the examiner palpates the post. Aspect of the pt’s sh. As the arm moves downward in forward flexion & adduction, the humeral head will be felt to sublux posteriorly.

Tests For Inferior &

Multidirectional Shoulder Instability

1. Test for Inferior Shoulder Instability ( Sulcus Sign ) The pt. stands w/ the arm by the side & sh.

Muscles relaxed. The examiner grasps the FA below the elbow & pulls the arm distally.

+ test: sulcus sign Sulcus sign grading: from the inf. Margin of

the acromion to the humeral head.+1 sulcus implies a distance of < 1cm+2 sulcus 1-2cm+3 sulcus > 3cm

2. Feagin Test

Stands w/ the arm abducted to 90˚ & the elbow extended & resting on the top of the examiner’s hands are clasped together over the pt’s humerus, bet. The upper & middle thirds. The examiner pushes the humerus down & forward.

+ test: look of apprehension on the pt’s face.

3. Rowe Test For multidirectional Instability Pt. stands forward flexed 45˚ at the wrist w/

the arms relaxed & pointing at the floor. The examiner places one hand over the sh. So that the index & middle fingers sit over the ant. Aspect of the humeral head & the thumb sits over the post. Aspect of the humeral head. The examiner then pulls the arm down slightly.

More traction is applied to the arm, & the sulcus sign is evident.

Tests for Impingemen

t

1. Neer Impingement Test The pt’s arm is passively & forcibly fully

elevated in the scapular plane w/ the arm medially rotated by the examiner.

+ test: pt’s shows pain Indicates an overuse injury to the

supraspinatus muscle & sometimes to the biceps tendon.

2. Hawkins-kennedy

The pt. stands while the examiner forward flexes the arm to 90˚ & then forcibly medially rotates the sh.

May also be performed of forward flexion

(vertically “circling the shoulder”) or horizontal adduction ( horizontally “circling the shoulder”)

+ test: pain indicates for supraspinatus paratenonitis/ tendinosis

3. Coracoid Impingement Sign

Same as the hawkins-kennedy test but involves horizontally adducting the arm across the body 10˚ to 20˚ before doing the medial rotation.

4. Yocum Test

Modification of coracoid impingment test Pt’s hand is placed on the opposite sh.

& the examiner elevates the elbow.

5. Impingement Test

Sitting. Examiner takes the arm to 90 abduction & full lateral rotation.

+ test: depends on production of the pt’s symptoms. Indicates a grade II or III sh. Lesion based on the Jobe’s classification

6. Reverse Impingement Sign ( Impingement Relief Test )

Used if the pt. has a (+) painful arc or pain on lateral rotation.

Supine. The examiner pushes the head of the humerus inferiorly as the arm is abducted or laterally rotated.

+ test: if the pain ↓ or disappears when repeating the movements w/ the humeral head depressed.

For mechanical impingement under the acromion

7. Posterior Internal Impingement Test

Supine. The examiner passively abducts the sh. To 90˚, w/ 15˚ to 20˚ forward flexion & maximum lateral rotation.

+ test: elicits localized pain in the post. Shoulder.

8. Internal (medial) Rotation Resistance Strength Test (IRRST)

Pt. stands w/ the arm abducted to 90 & laterally rotated 80 to 85˚. the examiner then applies an isometric resistance into lateral rotation followed by isometric resistance into medial rotation.

+ test: pt. who has a (+) impingement test if the pt. has a good strength in lateral rotation but not medial rotation & indicates an internal impingement.

If the pt. exhibits more weakness on lateral rotation, it indicates a classic external anterior impingement.

Tests For Labral Tears

1. Clunk Test

Supine. The examiner places one hand on the post. Aspect of the sh. Over the humeral head. The examiner’s other hand holds the humerus above the elbow. The examiner fully abducts the arm over the pt’s head. The examiner then pushes anteriorly w/ the hand over the humeral head while the other hand rotates the humerus into lateral rotation.

+ test: clunk or grinding sound & a tear of larum

2. Anterior Slide Test Sitting w/ the hands on the waist, thumbs

posterior. The examiner stands behind the pt. & stabilizes the scapula & clavicle w/ one hand. With the other hand, the examiner applies an anterosuperior force at the elbow.

If the labrum is torn, the humeral head slides over the labrum w/ the a pop or crack, & the pt. complains of pain.

3. Active Compression Test of O’Brien Standing w/ the arm forward flexed to 90˚ & the

elbow fully extended. The arm then horizontally adducted 10˚ to 15˚ (starting position) & medially rotated so the thumb faces downward. The examiner stands behind the pt. & applies a downward eccentric force to the arm. The arm is returned to the starting position & the palm is supinated, & the downward eccentric load is repeated.

+ test: if the pain or painful clicking is produced inside the sh. In the first part of the tes & eliminated or ↓ in the 2nd part.

4. Kim Test Sitting w/ back supported. The arm is

abducted to 90 w/ the elbow supported in 90 flexion. The examiner’s hand, while supporting the elbow & FA, applies an axial compression force to the glenoid through the humerus. While maintaining the axial compression force, the arm is elevated diagonally upward using the same hand while the other had applies a downward & backward force to the proximal arm.

+ test: sudden onset o post. Sh. Pain & click for posterior labral tear.

5.Biceps Tension Test Determines whether a SLAP lesion is

present Standing, abducts & laterally rotates

the arm 90˚ w/ elbow extended & FA supinated. The examiner then applies an eccentric adduction force to the arm.

+ test: reproduction of the pt’s symptoms

6. Biceps Load Test Designed to check the integrity of sup. Labrum. Supine w/ sh. Abducted to 90 & laterally rotated,

w/ the elbow flexed to 90˚ & FA supinated as it is for the apprehension or crank test. The examiner performs an apprehension test on the pt. by taking the arm into full lateral rotation. If apprehension appears, the examiner stops lateral rotation & holds the position. The pt. is then asked to flex the elbow against the examiner’s resistance at the wrist.

+ test: apprehension remains or becomes more painful.

7. SLAP Prehension Test Sitting or standing. The arm abducted to 90˚

w/ the elbow extended & the FA pronated ( thumb down & sh. Medially rotated). The pt. is then asked to horizontally adduct the arm. The mov’t is repeated w/ the FA supinated (thumb up & sh. Laterally rotated).

+ test: if the pt. feels pain in the bicipital groove in the first case (pronation) but the pain lessens or absent in the second case (supination), the test is consdered (+).

8. Labral Crank Test Supine or sitting. The examiner elevates the

arm to 160 in the scapular plane. In this position, an axial load is applied to the humerus w/ one hand of the examiner while the other hand rotates the humerus medially & laterally.

+ test: pain on rotation, especially lateral rotation w/ or w/out click or reproduction of pt’s symptoms.

9. Pain Provocation Test

Seated & the arm is abducted to bet. 90˚& 100˚, & the examiner laterally rotates the arm by holding the wrist. The FA is taken into maximum supination & then maximum pronation.

+ test: if the pain provoked in the pronated position

10. Compression Rotation Test

Supine. The examiner grasps the arm & flexes the elbow w/ the arm abducted to about 20°. The examiner then pushes or compresses the humerus in the glenoid by pushing up on the elbow while the examiner’s other hand rotates the humerus medially & laterally.

+ test: snapping or catching sensation when the humeral head is felt indicates a labral tear (Bankart or SLAP lesion).

Tests for Scapular Stability

1. Lateral Scapular Slide Test

Sits or stands w/ the arm resting at the side. The examiner measures the distance from the base of the spine of the scapula to the spinous process of T7-T9, or from T2 to the sup. Angle of the scapula. The pt. is then tested holding two of four other positions: 45° abduction ( hands on waist, thumbs posteriorly), 90° abduction w/ medial rotation, 120° abduction & 150° abduction.

The distance measured should not vary > 1-1.5cm (0.5 ton 0.75 inch) from the original measure.

2. Wall Pushup Test Stands arms length from a wall. The pt. is

then asked to do a “wall pushup” 15 to 20 times. Any weakness of the scapular muscles or winging shows up w/ 5 to 10 pushups.

3. Scapular Retraction Test Standing. The examiner, standing behind the

pt., places the fingers of one hand over the clavicle w/ the heel of the hand over the spine of the scapula to stabilize the clavicle & scapula & to hold the scapula retracted. The examiner’s other hand compresses the scapula against the chest wall.

4. Scapular Isometric Pinch( Squeeze Test ) Standing & asked to actively “pinch” or

retract the scapulae together as hard as possible & hold the position for as long as possible.

Normally, an individual can hold the contractions for 15 to 20 seconds w/ no burning pain or obvious muscle weakness.

If burning pain occurs in < 15 seconds, the scapular retractors are weak.

5. Scapular Assistance Test

Standing. The examiner places the fingers of one hand over the clavicle w/ the heel of the hand over the spine of the scapula. The examiner’s other hand holds the inferior angle of the scapula. As the pt. actively abducts or forward flexes the arm, the examiner stabilizes & pushes the inferior medial border of the scapula up & laterally while keeping the scapula retracted.

+ test: ↓ pain, it indicates that the scapular control muscles are weak as the assistance by the examiner simulates the activity of serratus anterior & lower trapezius during elevation.

Other Shoulder Joint Tests

1. Acromioclavicular Shear Test

Sitting. The examiner cups his/her hands over the deltoid muscle, w/ one hand on the clavicle & one hand on the spine of the scapula. The examiner then squeezes the heels of the hands together.

+ test: abnormal mov’t at the acromioclavicular jt.

2. Acromioclavicular Crossover, Crossbody, or Horizontal Adduction Test

Pt. stands & reaches the hand across to the opposite shoulder. The examiner passively forward flexes the arm to 90° & then horizontally adducts the arm as far as possible.

+ test: localized pain over the acromioclavicular jt.

3. Ellman’s Compression Rotation Test

Pt. lies on the unaffected side. The examiner compresses the humeral head into the glenoid while the pt. rotates the shoulder medially & laterally.

If pt’s symptoms are reproduced, GH arthritis is suspected.

Tests for Ligament Pathology

1. Crank Test

Test is done w/ the arm by the side (superior GH ligament & capsule)

At 45° to 60° abduction (middle GH ligament, coracohumeral ligament, inferior GH ligament (ant. Band) & anterior capsule)

Over 90° abduction (inferior GH ligament & anterior capsule)

2. Posterior Inferior GH Ligament Test

Pt. sits while the examiner forward flexes the arm to bet. 80 to 90 & then horizontally adducts the arm 40 w/ medial rotation. While doing the mov’t, the examiner palpates the posteroinferior region of the glenoid.

+ test: protrusion of the humerus or pain is felt in the area.

3. Coracoclavicular Ligament Test Side lying on the unaffected side w/ the hand

resting against the lower back. The examiner stabilizes the clavicle while pulling the inferior angle of the scapula away from the chest wall. Trapezoid is tested w/ the same position. The examiner stabilizes the clavicle & pulls the medial border of the scapula away from the chest wall.

+ test: pain in either case in the area of the ligament ( anteriorly under the clavicle bet. The outer one- third & inner two-thirds).

Test For Muscle or

Tendon Pathology

1. Speed’s Test ( Biceps or Straight-Arm

Test ) The examiner resists shoulder forward flexion

by the pt. while the patient's FA is first supinated, then pronated, & the elbow is completely extended.

may be performed by forward flexing pt's arm to 90° & then asking the pt. to resist an eccentric movement into extension first with the arm supinated, then pronated.

+ test: elicits ↓ tenderness in the bicipital groove especially w/ the arm supinated & is indicative of bicipital paratenonitis or tendinosis.

2. Yergason’s Test pt's elbow flexed to 90° & stabilized against the

thorax & w/ the forearm pronated, the examiner resists supination while the pt. also laterally rotates the arm against resistance.

If the examiner palpates the biceps tendon in the bicipital groove during the supination & lateral rotation movement, the tendon will be felt to "pop out" of the groove if the transverse humeral ligament is torn.

+ test: Tenderness in the bicipital groove alone without the dislocation may indicate bicipital paratenonitis/tendinosis.

3. Ludington’s Test

The pt. clasps both hands on top of or behind the head, allowing the interlocking fingers to support the weight of the upper limbs. The pt. then alternately contracts and relaxes the biceps muscles. While the pt. does the contractions and relaxations, the examiner· palpates the biceps tendon.

A positive result indicates that the long head of biceps tendon has ruptured.

4. Gilchrest's Sign

While standing, the pt. lifts a 2- to 3-kg (5- to 7-lb) weight over the head. The arm laterally rotated fully & lowered to the side in the coronal plane.

+ test: discomfort or pain the bicipital groove. Indicates bicipital paratenonitis or tendinosis.

5. Lippman’s Test

The pt. sits or stands the examiner holds the arm flexed to 90° with one hand. With the other hand, the examiner palpates the bicep tendon 7 to 8 cm (2.5 to 3 inches) below the glenohumeral joint & moves the biceps tendon from side to side in the bicipital groove.

+ test: sharp pain indicates bicipital paratenonitis or tendinosis.

6. Heuter's Sign

Normally, if elbow flexion is resisted when the arm is pronated, some supination occurs as the biceps attempts to help the brachialis muscle flex the elbow. This supination movement is called Heuter's sign. If it is absent, the distal biceps tendon has been disrupted

7. Supraspinatus ("Empty Can" or Jobe) Test

The pt's arm is abducted to 90° with neutral (no) rotation & the examiner provides resistance to abduction. The shoulder is then medially rotated & angled forward 30°(empty can position) so that the patient's thumbs point toward the floor in the plane of the scapula.

+ test: weakness or pain

8. Drop-Arm (Codman's) Test. The examiner abducts the pt's shoulder to

90° & then asks the pt. to slowly lower the arm to the side in the same arc of movement.

+ test: pt. is unable to return the arm to the side slowly or has severe pain when attempting to do so. It indicates a tear in the rotator cuff complex.

9. Abrasion Sign

The pt. sits & abducts the arm to 90° with the elbow flexed to 90°. The pt. then medially & laterally rotates the arm at the shoulder. Normally, there are no signs & symptoms.

If crepitus occurs, it is a sign that the rotator cuff tendons are frayed & are abrading against the under surfaces of the acromion process and the coracoacromial ligament.

10. Lift-Off Sign The pt stands & places the dorsum of the hand on

the back pocket or against the midlumbar spine. The pt. then lifts the hand away from the back.

+ test: An inability to do so indicates a lesion of the subscapularis muscle. Abnormal motion in the scapula during the test may indicate scapular instability.

If the pt. is able to take the hand away from the bank, the examiner should apply a load pushing the hand toward the back to test strength of the subscapularis & to test how the scapula acts under dynamic loading. With a torn subscapularis tendon, passive (and active) lateral rotation ↑.

If the pt’s hand is passively medially rotated as far as possible & the pt. is asked to hold the position, it will be found that the hand moves toward the back (subscapularis or medial rotation “spring back” or lag test) because subscapularis cannot hold the position due to weakness or pain.

Also called Modified Lift Off Test.

11. Abdominal Compression (Belly-Press Test) Standing. The examiner places a hand on the

abdomen so that the examiner feel how much pressure the pt. is applying to the abdomen. The pt. places his or her hand of the of the shoulder being tested on the examiner’s hand pushes the hand as hard as he or she can into the stomach (medial shoulder rotation). While pushing the hand into the abdomen, the pt. attempts to bring the elbow forward to the scapular plane causing greater medially shoulder rotation.

+ test: unable to maintain the pressure on the examiner’s hand while moving the elbow forward or extends the shoulder. Indicates a Tear of the subscapularis muscle.

12. Lateral Rotation Lag Sign (Infraspinatus “Spring Back” Test)

Seated or standing w/ the arm by the side & the elbow flexed to 90°. The examiner passively abducts the arm in the scapular plane, laterally rotates the shoulder to the end range, & asks the pt. to hold it.

+ test: the pt. cannot hold the position & the hand springs back anteriorly toward midline, indicating infraspinatus & teres minor cannot hold the position due to weakness or pain.

13. Hornblower’s (Signe de Clairon) Sign

Also called Patte Test Standing. The examiner elevates the pt’s

arm to 90° in the scapular plane. The examiner then flexes the elbow to 90, & the pt. is asked to laterally rotate the shoulder against resistance.

+ test: unable to laterally rotate the arm & indicates a tear of teres minor.

14. Infraspinatus Test

The patient should be standing, with the arm in a neutral position and the elbow flexed to 90 degrees.  The therapist will apply a medially directed force to the arm while the patient is instructed to resist. 

+ test: if the patient reports pain or weakness when resistance is applied.  

15. Teres Minor Test

Pt. lies prone & places the hand on the opposite posterior iliac crest. The pt. is then asked to extend & adduct the medially rotated arm against resistance.

+ test: pain or weakness indicates a teres minor strain.

16. Trapezius Weakness Sits down & places the hands together over the

head. The examiner stands behind the pt. & pushes the elbows forward.

Upper trapezius- by elevating the shoulder w/ the arm slightly abducted or to resisted shoulder abduction & head side flexion .

Middle trapezius- pt. in prone position w/ the arm abducted to 90° & laterally rotated. The test involves the examiner resisting horizontal extension of the arm watching for retraction of the scapula, w/c should normally occur. If scapular protraction occurs, the middle trapezius are

weak.

Lower trapezius- pt. is in prone lying w/ arm abducted to 120° & the shoulder laterally rotated. The examiner applies resistance to diagonal extension & watches for scapular retraction that should normally occur.If scapular protraction occurs, the lower

trapezius is weak. If scapula is elevated more than normal, it

may indicate a tight trapezius or the presence of cervical torticollis.

17. Serratus Anterior Weakness

Standing & forward flexes the arm to 90°. The examiner applies a backward force to the arm.

If SA is weak or paralyzed, the medial border of the scapula will wing ( classic winging ).

The pt. will also have difficulty abducting or forward flexing the arm above 90° w/ a weak SA, but it still may be possible w/ lower trapezius compensation.

18. Rhomboid Weakness Prone or sitting w/ the test arm behind the

body so the hand is on the opposite side. The examiner places the index finger along under the medial border of scapula while asking the pt. to push the shoulder forward slightly against resistance to relax the trapezius. The pt. then asked to raise the FA & hand away from the body.

If the rhomboids are normal, the thumb is pushed away from under the scapula.

19. Latissimus Dorsi Weakness

Standing w/ the arms elevated in the plane of the scapula to 160°. Against resistance of the examiner, the pt. is asked to medially rotate & extend the arm downward as if climbing a ladder.

20. Biceps Tightness Supine w/ the shoulder in extension over the

edge of the examining table w/ the elbow flexed & FA supinated. The examiner then extends the elbow, w/c would normally have a bone to bone end feel if the biceps is normal.

If the biceps is tight, full elbow flexion will not occur & the end feel will be muscular tissue stretch.

21. Triceps Tightness

Sitting. The arm is fully elevated through forward flexion & lateral rotation. While stabilizing the humerus, the examiner flexes the elbow.

Normally, end feel would be soft tissue approximation.

If the triceps is tight, elbow flexion will be limited & the end feel will be muscular tissue stretch.

22. Pectoralis Major Contracture Test Supine & clasps the hands together

behind the head. The arms then lowered until the elbows touch the examining table.

+ test: if the elbows do not reach the table & indicates a tight pectoralis major muscle.

23. Pectoralis Minor Tightness Supine. The examiner places the heel of the

hand over the coracoid process & pushes it toward the examining table.

Normally, the posterior mov’t occurs w/ no discomfort to the pt., & the scapula lies flat against the table. However, if there is tightness over the pectoralis minor during the posterior mov’t, the test would be considered positive.

24. Tightness of Latissimus Dorsi, Pectoralis Major, & Pectoralis Minor

Supine & asked the pt. to fully elevate the arms through forward flexion.

If the 3 muscles have normal length, the arm will extend to rest against the examining table, it indicates that the pecs minor, pecs major, or lats is tight.

Tests For Neurological

Function

1. Upper Limb Tension Test ULTT 1 ULTT 2 ULTT 3 ULTT 4

Shoulder Depression & abduction ( 100°)

Depression & abduction (10°)

Depression & abduction (10°)

Depression & abduction (10° 90°), hand to ear

Elbow Extension Extension Extension Flexion

Forearm Supination Supination Pronation Supination

Wrist Extension Extension Flexion &ulnar deviation

Extension & radial deviation

Fingers & thumb

Extension Extension Flexion Extension

Shoulder -------- Lateral rotation

Medial rotation

Lateral rotation

Cervical Spine Contralateral side flexion

Contralateral side flexion

Contralateral side flexion

Contralateral side flexion

Nerve Bias Median & Anterior Interosseous nerve, C5, C6,C7

Median & musculocutaneous nerve, axillary nerve

Radial nerve Ulnar nerve, C8 & T1 nerve roots

Tests for Thoracic Outlet

Syndrome

1. Roos Test (EAST) Stands & abducts the arm to 90°, laterally rotates

the shoulder, &flexes the elbows to 90° so that the elbows are slightly behind the frontal plane. The pt. then opens & closes the hands slowly for 3 mins.

Unable to keep the arms in the starting position for 3 mins. of suffers ischemic pain, heaviness or profound weakness of the arm, or numbness & tingling of the hand during the 3 mins.

Sometimes called positive abduction & external rotation (AER) position test, the “hands up” test, or the elevated arm stress test (EAST)

2. Wright Test or Maneuver Sitting. Hyperabducting the arm so that the

hand is brought over the head w/ the elbow & arm in the coronal plane w/ the shoulder laterally rotated.

Having the pt. take a breath or rotating or extending the head & neck may have an additional effect. The pulse is palpated for differences.

3. Modified Wright Test or Maneuver ( Allen Maneuver )

Sitting. The examiner flexes the pt’s elbow to 90° while the shoulder is extended horizontally & rotated laterally. The pt. then rotates the head away from the test side. The examiner palpates the radial pulse, w/c becomes absent (disappears) when the head is rotated away from the test side.

+ test: pulse disappearance

4. Costoclavicular Syndrome (Military Brace) Test

Examiner palpates the radial pulse & then draws the pt’s shoulder down & back.

+ test: absence of pulse This test is particularly effective in pts.

Who complain of symptoms while wearing a backpack or heavy coat.

5. Provocative Elevation Test Pt. elevates both arms above the

horizontal & is asked to rapidly open & close the hands 15 times.

+ test: if fatigue, cramping, or tingling occurs during the test, the test is positive for vascular insufficiency & TOS.

Modification of the Roos Test.

6. Shoulder Girdle Passive Elevation

Sits & the examiner grasps the pt’s arms from behind & passively elevates the shoulder girdle up & forward into full elevation ( a passive bilateral shoulder shrug ), & the position is held for 30 or more seconds.

7. Adson Maneuver

The examiner locates the radial pulse. The pt’s head is rotated to face the test shoulder. The pt. then extends the head while the examiner laterally rotates & extends the pt’s shoulder. The pt. is instructed to take a deep breath & hold it.

+ test: disappearance of the pulse

8. Halstead Maneuver

The examiner finds the radial pulse & applies a downward traction on the test extremity while the pt’s neck is hyperextended & the head is rotated to the opposite side.

+ test: absence or disappearance of a pulse.