Special Tests

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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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)
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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
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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
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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
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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
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