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Minnesota State University, Mankato

Minnesota State University, Mankato
Athletic Training

Special Tests

Page address: http://ahn.mnsu.edu/athletictraining/spata/shouldermodule/specialtests.html

Acromioclavicular Joint Compression Test

Steps
Patient is sitting or lying supine with the involved arm relaxed at the side
Examiner stands on the invovled side, placing one hand on the patient's clavicle and the other hand on the spine of the scapula
Examiner gently squeezes the hands together, noting any movement at the acromioclavicular joint
Positive Test
Pain and/or movement of the clavicle
Positive Test Implications
Acromioclavicular and/or coracoclavicular ligament sprain
See Test

Sternoclavicular (SC)/Acromioclavicular (AC) Joint Stress Test

Steps
Patient is sitting or lying supine with the involved arm relaxed
Examiner places one hand on the proximal end of the patient's clavicle and the other hand on the spine of the scapula
Examiner applies gentle inferior and posterior pressure on the clavicle
Test can also be repeated at the acromioclavicular joint
Positive Test
Pain and/or movement of the clavicle
Positive Test Implications
Sternoclavicular ligament sprain (SC joint stress test)/acromioclavicular and/or coracoclavicular ligament sprain
See Test

Empty Can Test

Steps
Patient stands with both shoulders abducted to 90°, horizontally adducted 30°, and internally rotated so the patient's thumbs face the floor
Examiner resists the patient's attempts to actively abduct both shoulders
Positive Test
Weakness and/or report of pain
Positive Test Implications
Involvement of the supraspinatus muscle and/or tendon
See Test

Yergason Test

Steps
Patient is sitting or standing with the elbow flexed to 90° and forearm positioned so that the lateral border of the radius faces upward (neutral position)
Examiner stands on the involved side and places one hand on the patient's forearm and the other near the bicipital groove
Examiner resists the patient's attempt to actively supinate the forearm and externally rotate the humerus
Positive Test
Pain and/or snapping in the bicipital groove
Positive Test Implications
Bicipital tendinitis or tear/laxity of the transverse humeral ligament
See Test

Speed's Test

Steps
Patient is sitting or standing with shoulder flexed to 90°, the elbow fully extended and the forearm supinated
Examiner places one hand on the patient's forearm and the other hand over the bicipital groove
Examiner resists the patient's attempt to actively flex the humerus forward
Positive Test
Tenderness and/or pain in the bicipital groove
Positive Test Implications
Bicipital tendinitis
See Test

Ludington's Sign Test

Steps
Patien sits or stands with fingers interlocked on the superior/posterior aspect of the head
Examiner stands behind the patient and bilaterally palpates the long head of the biceps
Patient contracts biceps brachii by applying force to the top of the head
Examiner notes any tension within the biceps tendon
Positive Test
Decreased or no tension is felt under the involved tendon; pain is increased
Positive Test Implications
Rupture of the long head of the biceps brachii tendon
See Test

Drop Arm Test

Steps
Patient is sitting or standing with the involved arm fully abducted
Patient then slowly lowers the arm back to their side
Positive Test
Patient is unable to slowly return the arm to the side and/or has significant pain when attempting to perform the task
Positive Test Implications
Rotator cuff pathology
See Test

Hawkins–Kennedy Impingement Test

Steps
Patient is sitting or standing with upper extremities relaxed
Examiner grasps the patient's elbow with one hand and the patient's wrist with the other hand
Examiner forward flexes the shoulder to 90 degrees° and then internally rotates the patient's shoulder
Positive Test
Pain and apprehension during the motion
Positive Test Implications
Possible shoulder impingement of the supraspinatus or long head of the biceps brachii tendon
See Test

Piano Key Sign Test (Spring Test)

Steps
Patient is sitting with involved arm relaxed at the side
Examiner applies pressure to the patient's distal clavicle in an inferior direction
Positive Test
Depression of the clavicle when pressure is applied and elevation of the clavicle when pressure is released
Positive Test Implications
Instability of the acromioclavicular joint
See Test

Anterior Apprehension Test

Steps
Patient is lying supine on the table with involved shoulder in 90° of abduction and the elbow in 90° of flexion
Examiner stands beside the patient supporting the humerus at midshaft while the forearm is grasped proximal to the wrist
Examiner slowly externally rotates the shoulder
Positive Test
Patient displays apprehension that the shoulder may dislocate and resists further movement
Positive Test Implications
Anterior capsule, inferior glenohumeral ligament, or gleniod labrum may have been comprised, allowing the humeral head to dislocate or sublux anteriorly
See Test

Posterior Apprehension Test

Steps
Patient is lying supine on the table
Examiner grasps patient's elbow with one hand and stabilizes the shoulder with the other hand
Examiner places the patient's shoulder in a position of 90° of flexion and internal rotation and applies a posterior force through the long axis of the humerus
Positive Test
Patient displays apprehension and produces muscle guarding to prevent the shoulder from subluxating posteriorly
Positive Test Implications
Laxity in the posterior glenohumeral capsule, torn posterior labrum
See Test

Sulcus Sign/Long Arm Traction/Inferior Apprehension Test

Steps
Patient is sitting with arm hanging at the side
Examiner stands lateral to the involved side
Examiner grips the patient's arm distal to the elbow and applies a downward (inferior) traction force to teh humerus
Positive Test
Excessive inferior humeral head translation with a visible and/or palpable "step–off" or "sulcus" deformity immediately inferior to the acromion; pain and/or movement of the scapula inferior to the clavicle; athlete follows downward movement of the arm
Positive Test Implications
Inferior and/or multidirectional instability; acromioclavicular and/or coracoclavicular ligament sprain, inferior instability
See Test

Anterior Drawer Test

Steps
Patient is supine with the glenohumeral joint positioned at the edge of the table
Examiner stands next to the involved shoulder
Examiner places one hand around the humerus below the surgical neck
The other hand stabilizes the scapula by placing the fingers behind the athlete on the spine of the scapula and the thumb over the coracoid process
Patient is relaxed while the examiner passively abducts the glenohumeral joint 70 to 80°, forward flexes 0 to 10°, and externally rotates 0 to 10°
Examiner stabilizes the scapula and firmly glides the head of the humerus anteriorly while applying slight distraction to the glenohumeral joint
Positive Test
Increased anterior translation of the humeral head relative to the scapula/glenoid fossa
Positive Test Implications
Anterior instability
See Test

Posterior Drawer Test

Steps
Patient is lying supine
Examiner stands next to involved shoulder
Examiner holds the patient's arm at the elbow, passively abducts the shoulder to 90°, and horizontally flexes the shoulder 20 to 30°
Examiner stabilizes the scapula by placing one other hand posterior to the shoulder joint capsule with the thumb over the coracoid process
Examiner stabilizes the scapula, internally rotates the humerus and applies downward pressure, pushing the humeral head posteriorly
Positive Test
Increased posterior instability of the humeral head relative to the scapula/glenoid fossa
Positive Test Implications
Posterior instabilit
See Test

Jobe Relocation Test

Steps
Patient is supine with shoulder abducted to 90° and elbow flexed to 90°
Examiner stands beside patient
Examiner grasps forearm proximally to the wrist to provide leverage during external rotation of the humerus
The opposite hand is placed over the humeral head
Examiner externally rotates the humerus until pain, discomfort or apprehension and then applies posterior pressure to relocate the subluxated joint
Positive Test
Decreased pain and/or increased range of motion compared with anterior apprehension test
Positive Test Implications
Anterior pain may be the result of increased laxity in the anterior ligamentous and capsular structures
Posterior pain may be from the impingement of the posterior capsule or labrum
See Test

Grind Test

Steps
Patient is lying supine with the shoulder abducted to 90° and elbow flexed to 90 degrees°
Examiner grasps the patient's elbow with one hand and the patient's proximal humerus with the other hand
Examiner applies compression to the glenoid labrum while attempting to rotate the humeral head 360 degrees° around the surface of the glenoid fossa
Positive Test
Grinding or clunking sensation
Positive Test Implications
Glenoid labrum tear to the specific location which is being compressed
See Test

Clunk Test

Steps
Patient is lying supine
Examiner places one hand on the posterior aspect of the patient's humeral head and the other hand proximal to the patient's elbow joint along the distal humerus
Examiner passively abducts and externally rotates the patient's arm overhead and applies an anterior force to the humerus and then circumducts the humeral head around the glenoid labrum
Positive Test
Grinding or clunking sensation
Positive Test Implications
Glenoid labrum tear
See Test

Active Compression Test (O'Brien's Test)

Steps
Patient is sitting or standing with shoulder in 90° of forward flexion, 30 to 45° of horizontal adduction and maximal internal rotation
Examiner stands with one hand grasping the patient's wrist (medially)
Patient horizontally adducts and flexes the shoulder against examiner's manual resistance
Test is repeated with the patient's arm in externally rotated position
Positive Test
Pain and/or popping present in internally rotated position but absent in externally rotated position
Positive Test Implications
SLAP (Superior Labrum Anterior to Posterior) tear
See Test

Adson's Maneuver Test

Steps
Patient is sitting or standing
Examiner stands with fingers over patient's radial artery
Examiner externally rotates and extends the patient's arm while palpating the radial pulse
Patient then extends and rotates the neck towards the test arm and takes a deep breath
Positive Test
Diminished or absent radial pulse
Positive Test Implications
Thoracic outlet syndrome or compression of the subclavian artery by the scalene muscles
See Test

Allen's Test

Steps
Patient is sitting or standing with shoulder in 90° of abduction and external rotation, and the elbow in 90° of flexion
Examiner stands with fingers over patient's radial pulse
Patient rotates the neck away from the test arm
Examiner palpates the radial pulse
Positive Test
Diminished or absent radial pulse
Positive Test Implications
Thoracic outlet syndrome
See Test

Provacative Elevation Test (Roos Test)

Steps
Patient is sitting or standing with both shoulders in 90° of abduction and external rotation, and the elbows in 90° of flexion
Patient rapidly opens and closes both hands for 3 minutes (like the chicken dance)
Positive Test
Inability to maintain the test position, diminished motor function of the hands, and/or loss of sensation in the upper extremities
Positive Test Implications
Thoracic outlet syndrome, neurovascular compromise
See Test

Military Brace Position Test

Steps
Patient is standing
Examiner stands behind the patient and assesses the radial pulse
Examiner passively extends and abducts the arm to 30°
Patient hyperextends the head and neck
Positive Test
Diminished or absent radial pulse
Positive Test Implications
Potential thoracic outlet syndrome
See Test

Pectoralis Major Contracture Test

Steps
Patient lies supine with both hands clasped together behind the head
Examiner stands behind the patient
Examiner passively moves the patient's elbows towards the table
Positive Test
Patient is unable to passively have their elbow(s) reach the table
Positive Test Implications
Pectoralis major muscle contracture
See Test

Cross–Over Impingement Test

Steps
Patient is sitting or lying supine
Examiner places one hand on the posterior aspect of the patient's shoulder and the other hand on the patient's elbow
Examiner stabilizes the patient's trunk and then passively and maximally horizontally adducts the test shoulder
Positive Test
Superior shoulder pain; anterior shoulder pain; posterior shoulder pain
Positive Test Implications
Acromioclavicular joint pathology (superior pain); Subscapularis, supraspinatus, and/or biceps long head pathology (anterior pain); Infraspinatus, teres minor, and/or posterior capsule pathology (posterior pain)
See Test

Railroad Whistle Test

Steps
Patient is sitting or standing with elbow and shoulder flexed to 90°
Examiner stabilizes opposite shoulder with one hand and places the other hand on the biceps of the involved arm
Examiner applies downward pressure while the patient resists the downward pressure
Positive Test
Decreased pain experienced during Speeds Test
Positive Test Implications
Bicipital tendinitis or impingement pathology
See Test

Swim Stroke Test

Steps
Patient is sitting or standing with arm relaxed
Examiner places one hand at the patient's wrist and the other hand at the elbow
Examiner passively moves patient's arm through front stroke range of motion
Positive Test
Patient experiences pain when taken through the swim stroke
Positive Test Implications
Impingement syndrome
See Test

Jerk Test

Steps
Patient is lying supine with arm horizontally abucted and elbow flexed to 90°
Examiner places stabilizes the opposite shoulder with one hand and places the other hand at the patient's involved elbow
Examiner forces the head of the humerus into the glenoid fossa
While maintaining pressure examiner horizontally adducts the patient's arm
Positive Test
Posterior apprehension and pain
Positive Test Implications
Possible posterior subluxation or dislocation
See Test

Neer Impingement Test

Steps
Patient is sitting or standing with upper extermities relaxed
Examiner grasps the patient's scapula (posteriorly) with one hand and the elbow (anteriorly) with the other hand
Examiner stabilizes the patient's scapula and then passively and maximally forward flexes the patient's shoulder
Positive Test
Shoulder pain and apprehension
Positive Test Implications
Shoulder impingement, particularly of the supraspinatus and biceps long head tendons
See Test