ANT APPREHENSION

1.  Pt supine, arm at 90/90 position

2.  Slowly bring into ER: + test if noted apprehension & will be uncomfortable – at point of discomfort, ease off

RELOCATION

3.  Apply pressure to ant shld (as simulated ligament)

4.  Take back into ER; if pt can go farther, test is + for GH instability, dislocation

RELEASE

5.  Remove pressure to ant shld

+ test for anterior instability

1.  Find pulse at wrist

2.  Pt SS, abduct arm all the way to head

3.  Test pulse again at wrist

+ for TOS (pec minor/coracoid compression type) if pulse is different

Roos test

Pt seated with arms at 90/90, elbows behind frontal plane

Open/close fists slowly for 3 mins

+ Test for THORACIC OUTLET SYNDROME if profound weakness or n/t

Adson maneuver

Roos test

Wright test

Costoclavicular syndrome test

same as Wright maneuver except:

1.  elbow bent at 90, shld at maximal HABD and ER

2.  Pt rotates head away from test side

Disappearing pulse + for TOS (scalene type)

1.  Assess radial pulse

2.  Draw pt arm down & back into ext

3.  Retest pulse

Absent pulse is + test for TOS (costoclavicular type)

1.  Assess radial pulse

2.  Pt rotates head to test side, & extends head

3.  Shld down/back into ER/ext

4.  Pt to take deep breath and hold it

5.  Reassess pulse

Absence of pulse is + test for TOS

(Scalene Triangle type)

Neer test

Hawkins-Kennedy test (anterior)

Load & Shift test

ULTT's

Drop-arm sign for RTC tear

o   Pt standing

o   Arms at sides, IR wrist so palm faces away from pt

o   Elevate shld in scaption w/ elbow straight, all the way to max ROM

o   OP in Abd direction

If painful, + for impingement

o   Pt standing

o   Shld @ 90 flex; elbow @ 90 flex

o   Holding wrist in place, apply pressure w/ other hand to underside of elbow into IR

Pain as + test for ANT shld impingement

o   Pt standing

o   Compress shld w/ 1h pressure

o   2h braces upper trap (glenoid shoved up in capsule)

o   1h  glides fwd/bwd

Test both sides, deficiency is + test for GH instability

1.  Pt. supine, shld abd at 90 and HABD across chest; 90 deg elbow flex

2.  Hold scap with nearest hand

3.  Apply post pressure through elbow w/ other hand

4.  Can rotate wrist into IR

Pain/apprehension/reproduction of symptoms indicate + test for posterior instability

Pt standing w/ arm at side relaxed

PT grasp forearm below elbow, pulls the arm distally

Gap between acromion and humeral head indicates + test for inferior instability/GH laxity

Pt seated/standing

Abduct arm to 90 deg

Standing beside pt, Rest pt's hand on PT shoulder, w/ palm down

Clasp hands over middle of pt humerus

Press inferiorly/anteriorly

A look of apprehension indicates + test for inferior/multdirectional instability

 pt supine or seated;

abduct shld at 120 deg;

PT grasp elbow, 2H on scap, 1H loads shld by pressing on elbow twd compression (compresses humeral head into glenoid fossa);

manip shld around labrum edge; also rotate into ER/IR

Pain or reproduced symptoms indicates + test for labral lesion

Pt supine

Arm abducted 90 degrees

Take into full ER, or to point of discomfort

pt to flex elbow against resistance (1H at wrist, 2H supports just prox to elbow)

If decreased apprehension or pain, test is -

If apprehension or pain increased, + test for SLAP lesion

For SLAP lesion detection:

Pt standing

Pt to put hands on hips so elbow is 45 flexed

PT to compress shld from elbow, into glenoid fossa as pt resists

For posterioinferior Labral Lesion

Pt sitting in chair w/ back support

-Shld abd 90 and elbow flexed 90

-PT applies compression to shld through elbow

-W/ this compression, arm elevated diagonally upward, while simulatneously applying down/back forces to mid-humerus

+ test w/ sudden onset of post shld pain and click

(photo - Magee 300)

Pt standing, shld 90 flexion and elbow in full ext

Arm adducted 15 degrees, w/ thumb down

Standing behind pt, 1H resists downward dist to elbow; 2H stabilizes post shld.

Test repeated w/ palm up.

+ for SLAP II if pain/clicking in shld RELIEVED w/ palm-up position

*IF POSITIVE:  "where does it hurt?" - if pt points to AC, is AC issue, anywhere else, prob labral.

Pt sitting or standing;

Shld flexed to 90 degrees w/ palm down

pressure at wrist, 2H supports shld

Then, turn pu:  same test, if shld feels same but biceps hurts, is straining biceps tendon:  

+ test for biceps tendon pathology (tendinosis/paratenoitis) or SLAP II

Pt sitting;

arm flexed 90 at elbow, pd;

PT to resist supination & ER through available range - grasp pt hand w/ armwrestle grip

(2H palpates biceps tendon - find by pron/supinating forearm, should roll under fingers or thumb)

+ test if biceps tendon "pops out" of groove; transverse humeral lig tear

IRRST (Internal Rotation Resistance Strength Test) +

ERRST (External Rotation Resistance Strength Test)

Pt standing, shld abd 90 deg + 85 deg ER

W/ 2H supporting elbow, resist w/ 1H at wrist into IR, and then ER. (pt holds arm steady in that position against resistance)

Weakness resisting IR + for Int impingement

Weakness resisting ER + for Ext impingement (classic)

PT elevates pt arm to 90 flex/abd

pt instruction to "slowly lower arm back into relaxed position"

Fast arm drop or severe pain with attempt is + for tear in RTC complex

Elevate in scaption

Pain at 60-120 degrees is + for RTC tear or impingement (greater tubercle against glenoid fossa)

If only painful at top of range, and pt can point to pain at AC joint, test is + for AC pathology

Have pt bring hands to mouth

If the shld goes into abd, is + test for teres minor pathology (fatty infiltration, likely); may be irreversible w/ surgery)

Arm abd 20 deg

Elbow flexed at 90 and shld at maximal ER

Apply overpressure into ER and ask pt to hold

If pressure released and arm springs back internally, test is + for full-thickness infraspinatus or supraspinatus tear

Pt standing/seated

Have pt place dorsum of hand on their own back

Have pt lift hand away

Inability to lift hand indicates + test for subscapularis tear

Pt flexes elbow at 90, while standing or SS

PT applies IR overpressure

If pt can't resist, test is + for infraspinatus tear

*also indicated by ER arm that falls into IR when released