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2 Pearson Education Limited Edinburgh Gate Harlow Essex CM20 2JE England and Associated Companies throughout the world Visit us on the World Wide Web at: Pearson Education Limited 2014 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without either the prior written permission of the publisher or a licence permitting restricted copying in the United Kingdom issued by the Copyright Licensing Agency Ltd, Saffron House, 6 10 Kirby Street, London EC1N 8TS. All trademarks used herein are the property of their respective owners. The use of any trademark in this text does not vest in the author or publisher any trademark ownership rights in such trademarks, nor does the use of such trademarks imply any affiliation with or endorsement of this book by such owners. ISBN 10: ISBN 10: ISBN 13: ISBN 13: British Library Cataloguing-in-Publication Data A catalogue record for this book is available from the British Library Printed in the United States of America

Physical Examination Tests for the Shoulder Complex Please refer to the chapter Introduction to Diagnostic Accuracy before reading this chapter. Eric J.

3 Physical Examination Tests for the Shoulder Complex Please refer to the chapter Introduction to Diagnostic Accuracy before reading this chapter. Eric J. Hegedus Screening for Bony Abnormality Olecranon-Manubrium Percussion Test (Fracture or Dislocation between the Elbow and Manubrium) Index of Tests The Bony Apprehension Test (A Bony Lesion Causing Anterior Instability of the Shoulder) Torn Rotator Cuff/Impingement External Rotation Lag Sign (Supraspinatus/Infraspinatus Tear) Rent Test [Rotator Cuff (RC) Tear] Supine Impingement Test (RC Tear) Lift-Off Test (Subscapularis Tear) Internal Rotation Lag Sign (Subscapularis Tear) Drop Sign (Infraspinatus Tear, Irreparable Fatty Degeneration of Infraspinatus) Empty Can Test/Supraspinatus Test (Rotator Cuff Tear, All Stages of Impingement Syndrome from Bursitis through a Rotator Cuff Tear) Belly Press/Napoleon Test (Subscapularis Tear) Bear-Hug Test (Subscapularis Tear) Lateral Jobe Test (RC Tear) Drop Arm Test (Supraspinatus Tear, Subacromial Impingement) Full Can/Supraspinatus Test (Supraspinatus Tear) Posterior Impingement Sign (Rotator Cuff Tear and/or Posterior Labral Tear) Hornblower s Sign (Irreparable Fatty Degeneration of Teres Minor) Whipple Test (Supraspinatus Tear) Diagnostic Clusters Rotator Cuff Tear Impingement Tests Internal Rotation Resisted Strength Test (Internal/Intraarticular vs. External/Subacromial Impingement) Infraspinatus/External Rotation Resistance Test (All Stages of Subacromial Impingement) Neer Test (Subacromial Impingement, Subacromial Bursitis (SAB), Rotator Cuff Tear, Superior Labral Tear) Hawkins-Kennedy Test (Subacromial Impingement, Subacromial Bursitis, Rotator Cuff Tear, Superior Labral Tear) Painful Arc Test (All Stages of Subacromial Impingement) Cross-Body Adduction Test [Subacromial Impingement, Acromioclavicular (AC) Joint Damage] Diagnostic Clusters Impingement From Chapter 6 of Orthopedic Physical Examination Tests: An Evidence-Based Approach, Second Edition. Chad Cook, Eric Hegedus. Copyright 2012 by Pearson Education, Inc. All rights reserved. 161

4 Torn Labrum/Instability Tests Physical Examination Tests for the Shoulder Complex Biceps Load Test II (SLAP Lesion) Yergason s Test (Subacromial Impingement, Superior Labral Anterior to Posterior (SLAP) Lesion, Any Labral Lesion, Long Head of Biceps Pathology) Crank Test (Labral Tear, SLAP Lesion) Kim Test (Posteroinferior Labral Lesion) Jerk Test (Posteroinferior Labral Lesion) Anterior Release/Surprise Test (Anterior Instability) Pain Provocation Test (SLAP Lesion) Passive Compression Test (SLAP Lesion) Apprehension Test (Anterior Instability, All Instabilities of the Glenohumeral Joint, Labral Tear, SLAP Lesion) Modified Dynamic Labral Shear Test (Labral Tear) Modified Relocation/Modified Jobe Relocation Test (Labral Pathology, Traumatic Anterior Instability) Apprehension-Relocation/Jobe Relocation Test (Anterior Instability, Labral Tear, SLAP Lesion) Supine Flexion Resistance Test (Type II SLAP Lesion) Speed s Test [All Stages of Subacromial Impingement, Superior Labral Anterior to Posterior (SLAP) Lesion, Any Labral Lesion, Biceps Pathology] Forced Shoulder Abduction and Elbow Flexion Test (Superior Labral Tear) Sulcus Sign (Inferior Laxity, Superior Labral Tear) Active Compression Test/O Brien s Test [Labral Tear, SLAP Lesion, Labral Abnormality, Acromioclavicular (AC) Joint Pathology] Resisted Supination External Rotation Test (RSERT) (SLAP Lesion) Compression-Rotation Test (SLAP Lesion) Anterior Slide Test (SLAP Lesion) Biceps Load Test (SLAP Lesion with Anterior Shoulder Dislocation) Clunk Test (Labral Tear, Superior Labral Tear) Anterior Drawer Test (Anterior Laxity, Anterior Instability) Biceps Tension Test (Unstable Superior Labrum Lesions/SLAP Lesions) Hyperabduction Test (Inferior Laxity) Posterior Drawer Test (Posterior Laxity) Load and Shift Test (Anterior, Posterior, Inferior Laxity) Diagnostic Clusters Instability Diagnostic Clusters Labral Tears Acromioclavicular (AC) Dysfunction Tests AC Resisted Extension Test (AC Joint Abnormality) AC Joint Palpation (AC Joint Pain) Paxinos Sign (AC Joint Pain) Diagnostic Clusters AC Joint Pathology Nerve Palsies Active Elevation Lag Sign (Spinal Accessory Nerve Palsy) The Triangle Sign (Spinal Accessory Nerve Palsy) Deltoid Extension Lag Sign (Axillary Nerve Palsy) Stiffness-Related Disorders [Osteoarthritis (OA) & Adhesive Capsulitis] Shrug Sign (OA & Adhesive Capsulitis) Coracoid Pain Test (Adhesive Capsulitis) Diagnostic Clusters Adhesive Capsulitis 162

5 Test For Scapular Dysfunction Lateral Scapular Slide Test (Shoulder Dysfunction) Physical Examination Tests for the Shoulder Complex Tests For Biceps Tendinopathy Upper Cut Test (Biceps Tendinopathy) Biceps Palpation (Biceps Tear, Type II SLAP) Diagnostic Clusters Biceps Tendinopathy 163

Physical Examination Tests for the Shoulder Complex SCREENING FOR BONY ABNORMALITY Olecranon-Manubrium Percussion Test (Fracture or Dislocation between the Elbow and Manubrium) 1 The patient is

6 Physical Examination Tests for the Shoulder Complex SCREENING FOR BONY ABNORMALITY Olecranon-Manubrium Percussion Test (Fracture or Dislocation between the Elbow and Manubrium) 1 The patient is seated or standing with arms crossed. 2 The examiner taps on the involved side olecranon while using a stethoscope placed on the patient s manubrium. 3 Repeat step 2 but on the uninvolved side. 4 A positive test for fracture or dislocation is indicated by a difference in the quality of sound on the involved vs. the uninvolved side. UTIlITy ScOrE 2 Study Reliability Sensitivity Specificity LR+ LR QUADAS Score (0 14) Adams et al. 1 NT Comments: According to Adams et al., when the Olecranon-Manubrium Percussion Test 1 is positive, the clinician should order an x-ray. More research needs to be done to raise the Utility Score to a

Physical Examination Tests for the Shoulder Complex SCREENING FOR BONY ABNORMALITY The Bony Apprehension Test (A Bony lesion causing Anterior Instability of the Shoulder) 1 The patient is seated or

7 Physical Examination Tests for the Shoulder Complex SCREENING FOR BONY ABNORMALITY The Bony Apprehension Test (A Bony lesion causing Anterior Instability of the Shoulder) 1 The patient is seated or standing. 2 The examiner stands behind the patient and grasps the suprascapular/supraclavicular region with one hand and the patient s proximal forearm with the other hand. 3 With the elbow flexed to 90 degrees, the examiner abducts the shoulder to 45 degrees or less and externally rotates the shoulder to 45 degrees or less. 4 A positive test for anterior instability due to a bony lesion is indicated by the patient registering apprehension with the test. UTIlITy ScOrE 2 Study Reliability Sensitivity Specificity LR+ LR QUADAS Score (0 14) Bushnell et al. 7 NT Comments: The Bony Apprehension Test 7 appears to be a screen for instability due to a Bankart or Hill-Sachs lesion but also has moderate diagnostic ability. More research needs to be done to raise the Utility Score to a

Evidence- Based Examination of the Shoulder Presented by Eric Hegedus, PT, DPT, MHSC, OCS, CSCS Practice Sessions/Skill Check- offs

Evidence- Based Examination of the Shoulder Practice Session & Skills Check- offs Evidence- Based Examination of the Shoulder Presented by Eric Hegedus, PT, DPT, MHSC, OCS, CSCS Practice Sessions/Skill