Position:
Seated
Performance:
Patient's arm is passively and forcibly fully elevated in the scapular plane, the arm is also medially rotated by the examiner.
Positive:
Pain indicated a positive result.
Positive test is indicative of an overuse injury to the supraspinatus and at times biceps tendon.
Note: Positive test with lateral rotation, examiner should check arcomioclavicular joint.
Saturday, March 14, 2009
Inferior Shoulder Instability (Sulcus Sign) Test
Position:
Standing
Performance:
Patients arm is by the side and shoulder relaxed. Examiner grasps the patient's forearm below the elbow and pulles arm distally.
Positive:
Presence of Sulcus sign indicates inferior shoulder instability or glenohumeral laxity.
Sulcus Sign grading. (Measuring from inferior margin of the acromion to the humeral head)
+1 Sulcus implies a distance of less then 1 cm
+2 Sulcus implies a distance of 1-2 cm
+3 Sulcus implies a distance of more then 2 cm
Note: For best result test should be performed in the position in which sensation of instability was reported.
Standing
Performance:
Patients arm is by the side and shoulder relaxed. Examiner grasps the patient's forearm below the elbow and pulles arm distally.
Positive:
Presence of Sulcus sign indicates inferior shoulder instability or glenohumeral laxity.
Sulcus Sign grading. (Measuring from inferior margin of the acromion to the humeral head)
+1 Sulcus implies a distance of less then 1 cm
+2 Sulcus implies a distance of 1-2 cm
+3 Sulcus implies a distance of more then 2 cm
Note: For best result test should be performed in the position in which sensation of instability was reported.
Posterior Drawer Test Shoulder
Position:
Supine
Performance:
Step 1
While standing at the patients shoulder level, examiner grasps patients proximal forearm with one hand, flexing elbow to 120 degrees, shoulder abduction to 80-120 degrees and forward flexion (shoulder) 20-30 degrees. With other hand examiner stabilizes patients scapula with index and middle fingers on the spine of the scapula and thumb on corocoid process.
Step 2
Examiner rotates the upper arm medially and forward flexes the shoulder to 60-80 degrees. At the same time places the thumb from corocoid process to head of the humerus and applies posterior pressure. Head of he humerus can be felt by the index and middle fingers.
Positive:
Significant posterior translation ( >50% humeral head diameter) indicates a positive test.
Note: Although test is usually pain free the signs of apprehension may be shown.
Supine
Performance:
Step 1
While standing at the patients shoulder level, examiner grasps patients proximal forearm with one hand, flexing elbow to 120 degrees, shoulder abduction to 80-120 degrees and forward flexion (shoulder) 20-30 degrees. With other hand examiner stabilizes patients scapula with index and middle fingers on the spine of the scapula and thumb on corocoid process.
Step 2
Examiner rotates the upper arm medially and forward flexes the shoulder to 60-80 degrees. At the same time places the thumb from corocoid process to head of the humerus and applies posterior pressure. Head of he humerus can be felt by the index and middle fingers.
Positive:
Significant posterior translation ( >50% humeral head diameter) indicates a positive test.
Note: Although test is usually pain free the signs of apprehension may be shown.
Posterior Apprehension or Stress Test
Position:
Supine or Sitting
Performance:
Examiner elevates patients shoulder to 90 degrees in the plane of the scapula. Then examiner applies posterior pressure on the patients elbow. While the pressure (axial load) is applied, examiner horizontally adducts and medially rotates patients arm.
Positive:
Test is considered positive if the sign of apprehension, alarm on the face, patient's resistance to further motion or reproduction of symptoms are noted.
Note: Presence of pain is more likely with a positive test.
Supine or Sitting
Performance:
Examiner elevates patients shoulder to 90 degrees in the plane of the scapula. Then examiner applies posterior pressure on the patients elbow. While the pressure (axial load) is applied, examiner horizontally adducts and medially rotates patients arm.
Positive:
Test is considered positive if the sign of apprehension, alarm on the face, patient's resistance to further motion or reproduction of symptoms are noted.
Note: Presence of pain is more likely with a positive test.
Friday, March 13, 2009
Anterior Drawer Test Shoulder
Position:
Supine
Performance:
Examiner hold the patients arm of the affected shoulder in a manner that patient is relaxed. Shoulder in testing is abducted to 80-120 degrees, forward flex up to 20 degrees, and laterally rotated up to 30 degrees. With opposite hand examiner stabilizes patients scapula, pushing spine of the scapula forward with middle and index fingers while the thumb applies pressure to the coracoid process. With the hand that holds patients arm, examiner draws humerus forward.
Performed bilaterally.
Positive:
Depending on the amount anterior translation the test is considered positive.
Clicking sound may indicate slippage of the humeral head over glenoid rim or a labral tear.
Supine
Performance:
Examiner hold the patients arm of the affected shoulder in a manner that patient is relaxed. Shoulder in testing is abducted to 80-120 degrees, forward flex up to 20 degrees, and laterally rotated up to 30 degrees. With opposite hand examiner stabilizes patients scapula, pushing spine of the scapula forward with middle and index fingers while the thumb applies pressure to the coracoid process. With the hand that holds patients arm, examiner draws humerus forward.
Performed bilaterally.
Positive:
Depending on the amount anterior translation the test is considered positive.
Clicking sound may indicate slippage of the humeral head over glenoid rim or a labral tear.
Prone Anterior Instability Test
Position:
Prone
Performance:
Patients arm is abducted to 90 degrees and laterally rotated to 90 degrees. With one hand examiner hold patients arm in that position while the other hand pushes the humeral head forward.
Positive:
Test is positive if patients symptoms are reproduced.
Prone
Performance:
Patients arm is abducted to 90 degrees and laterally rotated to 90 degrees. With one hand examiner hold patients arm in that position while the other hand pushes the humeral head forward.
Positive:
Test is positive if patients symptoms are reproduced.
Apprehension (Crank) Test
Primarily designed to test for traumatic instability problems causing gross or anatomical instability of the shoulder.
Position:
Supine
Performance:
Examiner abducts patients hand to 90 degrees and slowly laterally rotates the shoulder.
Note: By placing a hand under Glenohumeral joint to act as a fulcrum the test becomes the Fulcrums Test.
Positive:
The test in considered positive if signs of apprehension or alarm on the patients face and resistance to further motion is noted.
Position:
Supine
Performance:
Examiner abducts patients hand to 90 degrees and slowly laterally rotates the shoulder.
Note: By placing a hand under Glenohumeral joint to act as a fulcrum the test becomes the Fulcrums Test.
Positive:
The test in considered positive if signs of apprehension or alarm on the patients face and resistance to further motion is noted.
Scalene Cramp Test
Position:
Seated
Performance:
Patient rotates the head to affected side and pulls chin down into the hollow above the clavicle by flexing cervical spine.
Positive:
Pain is usually in the trigger points of the scalenes toward which the head is rotated.
Radicular pain may indicate a plexopathy or TOS (Thoracic Outlet Syndrome)
Seated
Performance:
Patient rotates the head to affected side and pulls chin down into the hollow above the clavicle by flexing cervical spine.
Positive:
Pain is usually in the trigger points of the scalenes toward which the head is rotated.
Radicular pain may indicate a plexopathy or TOS (Thoracic Outlet Syndrome)
Jackson's Compresion Test
This test is a modification of Foraminal Compression (Spurling's) Test
Position:
Seated
Performance:
Patient rotates head to one side. Examiner then carefully presses down on the head.
Performed bilaterally.
Positive:
Pain radiating down the arm indicated nerve root compression.
Position:
Seated
Performance:
Patient rotates head to one side. Examiner then carefully presses down on the head.
Performed bilaterally.
Positive:
Pain radiating down the arm indicated nerve root compression.
Shoulder Depression Test
Used to evaluate brachial plexus for lesions, plexopathies and radiculopathies.
Position:
Seated
Performance:
Examiner side flexes the head to one side and applies a downward pressure on the opposite shoulder.
Performed bilaterally.
Positive:
Pain on the side of the compression indicates irritation or compression nerve root or foraminal irritation.
Pain on the side of the stretch indicates hypomobile joint capsule or a nerve sleeve irritation.
Position:
Seated
Performance:
Examiner side flexes the head to one side and applies a downward pressure on the opposite shoulder.
Performed bilaterally.
Positive:
Pain on the side of the compression indicates irritation or compression nerve root or foraminal irritation.
Pain on the side of the stretch indicates hypomobile joint capsule or a nerve sleeve irritation.
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