Shoulder Evaluation

Part 3 Shoulder Evaluation

Special Tests (31) • Fracture/sprain test (1) • Rotator cuff tests (6) • Glenohumeral instability tests (11) • Biceps tendon tests (6) • Impingement tests (3) • Thoracic outlet tests (4)

Apprehension Test (GH instability): • Pt. begins in seated or supine w/ shoulder relaxed, elbow flexed to 90 degrees, and arm abducted to 90 degrees • Examiner then passively externally rotates pt’s arm, looking for resistance, slipping, or obvious signs of apprehension • If pt demonstrates or exhibits any of the preceding signs, test is positive for anterior glenohumeral capsule laxity

Load and Shift Test (GH instability): • Pt begins supine w/ shoulder in neutral • Examiner palpates the pt’s humeral head and attempts to translate it anteriorly • Test is repeated at 45 and 90 degrees of abduction • Test is positive for anterior glenohumeral capsule laxity if the examiner can palpate and/or the pt can sense slipping of the humeral head anteriorly

Cross Arm Test (GH instability): • Examiner begins by facing the standing pt • Examiner passively crosses the pt’s arms and simultaneously pulls both of the pt’s arms across the body • Examiner then changes the directions and repeats the test • For example, if the left arm was initially on top, the arms should be positioned so that the right arm is on top for the second portion of the test • If pt experiences pain, the test is positive for glenohumeral capsule (most likely posterior) sprain

Sulcus Sign (GH instability): • Pt either seated or standing with the arms relaxed at the sides • Examiner palpates the humeral head with one hand and grasps the pt’s distal arm at the wrist with the other hand • Examiner then pulls inferiorly on the pt’s arm, looking for inferior movement • A positive sulcus will typically demonstrate a “dimple” where the humeral head should be when it is pulled inferiorly • The dimple will disappear when the arm is released • If inferior translation is apparent, the test is positive for inferior glenohumeral capsule laxity.

Pistoning Test (GH instability): • Pt begins in the supine position with the shoulder hanging off of the examination table • Examiner grasps pt’s arm medially at or near the bicep and laterally at the elbow • Examiner then manipulates the pt’s arm so that the arm is first lifted anteriorly and superiorly, then inferiorly and posteriorly • In this way, the pt’s shoulder is moved in the shape of a circle • Pain or apprehension indicates a positive test for anterior and/or posterior glenohumeral instability.

Anterior-Posterior (A-P) Drawer Test (GH instability): • Pt begins from the supine position with the arm abducted to 90 degrees and the shoulder unsupported and off of the table • Examiner then uses both hands (interlocked) to grasp the pt near the tricep • Examiner then slowly moves the pt’s arm so as to translate the humeral head anteriorly and posteriorly • This is performed simply by pulling up on the proximal arm and then releasing • Test is positive for anterior and/or posterior glenohumeral instability if the examiner observes noticeable excessive movement or laxity

Clunk Test (GH instability): • Examiner begins by placing one hand over the anterior and posterior aspects of the pt’s shoulder (the humeral head is palpated) while the other hand is used to grasp the pt’s distal humerus just above the elbow • Examiner then passively internally and externally rotates the pt’s arm in varying degrees of abduction and flexion • A palpable “clunking” or grinding sensation indicates a positive test and is indicative of a possible glenoid labrum tear • Obvious apprehension may indicate anterior glenohumeral instability

Relocation (Fowler’s) Test (GH instability): • Pt begins from the supine position with the shoulder supported by the examination table and abducted to 90 degrees • Pt’s elbow is also flexed to 90 degrees. The examiner then exerts a downward pressure to the humeral head (at the anterior shoulder) • Pain on reduction (after pressure is removed) indicates a positive test for glenohumeral instability.

Feagin Test (GH instability): • Pt begins standing with the involved shoulder positioned facing the examiner • Examiner places distal aspect of the pt’s extended arm over one of the examiner’s shoulders. • Examiner then cups the pt’s shoulder at the inferior to medial aspect of the deltoid using both hands with an interlocked grip • Examiner then exerts a “down and back” pressure to the pt’s proximal arm • This effectively pulls the pt’s arm closer toward the examiner • Apprehension indicates a positive test for anterior and/or inferior instability

Rowe Multidirectional Instability Test (GH instability): • Pt begins forward flexed to 45 degrees at the waist with the arms relaxed and pointed toward the floor • Examiner then places one hand over the pt’s shoulder so that the examiner’s index and middle fingers rest over the anterior aspect of the shoulder while the thumb rests over the posterior aspect • Examiner then pulls down on the pt’s arm (in a manner similar to a sulcus test) • Pain indicates a positive test for inferior glenohumeral instability • From this position, the examiner then passively extends the pt’s shoulder to 20 to 30 degrees from the vertical position and pushes the humeral head anteriorly • Pain indicates a positive test for anterior glenohumeral instability • Examiner finally passively flexes the pt’s shoulder to 20 degrees from the vertical position and pushes the humeral posteriorly • Pain indicates a positive test for posterior glenohumeral instability.

Rockwood Test (GH instability): • Examiner begins positioned behind the seated athlete • Examiner then basically performs a clunk test at different angles of abduction, including 0 degrees, 45 degrees, 90 degrees, and 120 degrees • Test is positive if pt displays apprehension with posterior pain when the arm is abducted to 90 degrees • Positive test also presents as uneasiness and pain at both 45 degrees and 120 degrees • 0 degrees rarely displays apprehension

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Shoulder Evaluation