Shoulder Special Tests

External Impingement Neer’s Hawkins Kennedy Empty Can Test

Neer’s Test For: External Impingement Posture: Patient seated with examiner standing Fixation: Ipsilateral scapula to prevent protraction Test: Passive forward elevation of the arm Positive: Pain in the shoulder Modifications: Internal and external rotation of humerus

Hawkins Kennedy For: External Impingement Posture: Patient seated with arm in 90° forward elevation Test: Passive forced internal rotation at different degrees of ab/adduction Positive: Pain in the shoulder

Empty Can Test For: External Impingement Posture: Patient seated with arm in 90° abduction, 30° horizontal adduction and full internal rotation Test: Resist abduction/flexion Positive: Pain in the shoulder; muscle weakness Modification: Repeat with full external rotation to reduce pain

Internal Impingement Posterior Internal Impingement

For: Internal Impingement Posture: Patient supine, 90° abduction and maximal external rotation Test: Maximal Passive external rotation Positive: Pain POSTERIORLY

Rotator Cuff Tests External Rotation Lag Sign Belly Press Test

External Rotation Lag Sign For: Posterior Cuff Integrity Posture: Patient seated with the back towards the examiner. The shoulder in 20º abduction, the elbow in 90º flexion and maximal external rotation minus 5º to avoid elastic recoil in the shoulder. Test: Maintain this position Positive: Unable to maintain position

Belly Press Test For: Subscapularis Integrity Posture: Patient seated with arm 45° and full internal rotation Test: Resist further internal rotation Positive: Weakness present

SLAP Tests Anterior Slide Test Biceps Load II Test O’Brien’s Test

Anterior Slide Test For: SLAP Posture: standing or sitting, hands on the hips with the thumbs pointing posteriorly. Fixation: the examiner places one hand on top of the shoulder from posterior, with the index finger over the anterior aspect of the acromion. The other hand is placed behind the elbow. Test: A forward and slightly superior directed force is supplied to the elbow and upper arm. The patient is asked to push against this force Positive: pain or a click in the front of the shoulder under the examiner’s hand.

Biceps Load II For: SLAP Posture: Supine with arm abducted to 120° and maximally externally rotated, elbow at 90° and forearm supinated. Test: Resist elbow flexion Positive: Pain

Instability Tests Apprehension Test Relocation Test

Apprehension Test For: Anterior Instability Posture: Patient supine, 90° abduction and maximal external rotation Test: Anterior force through posterior aspect of humeral head Positive: Apprehension or pain

Relocation Test For: Anterior Instability Posture: Patient supine, 90° abduction and maximal external rotation Test: Posterior force through anterior aspect of humeral head Positive: Relief of pain

Acromioclavicular Tests O’Brien Test AC Joint Tenderness Test Horizontal Adduction

O’Brien Test For: AC Joint Dysfunction or SLAP Posture: Patient standing in front of examiner. Arm 90° forward flexion, ° adduction and full internal rotation Test: Resist Flexion. Repeat with supinated wrist Positive: Pain over ACJ when in internal rotation OR Pain in shoulder

AC Joint Tenderness Test For: AC Joint Dysfunction Posture: Patient sitting Test: Palpation ACJ Positive: Pain over ACJ

Horizontal Adduction For: AC Joint Dysfunction Posture: Patient sitting Test: Passive Horizontal Adduction Positive: Pain over ACJ