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Shoulder Special Tests: A Diagnostic Tool for Physiotherapists

In this article, we are going to look at the shoulder joint special test. Along with the diagnostic imaging modalities, these are consider as the important diagnostic tool. Special tests are the vital part of shoulder joint assessment. For accurate results, careful performance of test is required. Every physiotherapist must know about these special tests for making diagnosis.

Special tests for Rotator Cuff Tears

Empty Can Test (Jobe’s Test):

Supraspinatus muscle is assessed using empty can test.

Procedure: To perform the test, the patient is asked to raise their arms forward in scapular pain with the thumb pointing downward. The examiner then applies downward pressure on the patient’s forearm.

Indication: Pain in the supraspinatus region means the test is positive.

Drop Arm Test:

Along with the empty can this test is also used to assess the supraspinatus muscle.

Procedure: To perform the test, the patient is asked to raise their arm out to the side at shoulder height, with the elbow straight. The patient is then asked to slowly lower their arm to their side.

Indication: A positive test is indicated by the patient being unable to lower their arm slowly and pain in the supraspinatus region when the arm is lowered.

empty can and drop arm test  for rotator cuff tear,

Shoulder Impingement Syndrome special tests

Neer Impingement Test:

This special test is used to assess the shoulder impingement syndrome.

Procedure: To perform the Neer impingement test, the patient sits or stands with their arm hanging by their side. The examiner stands behind the patient and places one hand on the patient’s shoulder. Other hand of examiner grasps the patient’s arm just below the elbow.

The examiner then passively raises the patient’s arm forward and up, until the arm is at about 90 degrees of flexion. Then applies gentle pressure downward on the patient’s arm.

 Indication: A positive test is indicated by pain in the subacromial space.

Hawkins-Kennedy Test:

Shoulder impingement syndrome is also assessed with Hawkins-Kennedy Test

Procedure: To perform the Hawkins-Kennedy impingement test, the patient sits or stands with their arm hanging by their side. The examiner stands behind the patient and places one hand on the patient’s shoulder. While the other hand grasps the patient’s arm just below the elbow.

The examiner then passively flexes the patient’s arm at the elbow to 90 degrees. Then internally rotates the patient’s arm at the shoulder.

Indication: Pain in the subacromial space indicates a positive test.

neer test and hawkin kenedy test  for Shoulder Impingement Syndrome

Special test for Glenohumeral Instability

Apprehension Test:

Healthcare providers use the apprehension test to assess anterior instability of the shoulder joint.

Procedure: To perform the apprehension test, the patient sits or stands with their arm hanging by their side. The examiner stands behind the patient and places one hand on the patient’s shoulder. The healthcare provider uses the other hand to grasp the patient’s arm just below the elbow.

The examiner then passively abducts the patient’s arm to 90 degrees and externally rotates the arm. Asks the patient if they feel any apprehension or fear of their shoulder dislocating.

Indication: The patient feeling apprehension or fear of their shoulder dislocating indicates a positiv test.

Relocation Test:

Physiotherapist use this special test to differentiate between pain caused by instability and pain caused by impingement.

Procedure: To perform the test, the patient sits or stands with their arm hanging by their side. The examiner places one hand on the patient’s shoulder.

Then passively abducts the patient’s arm to 90 degrees and externally rotates the arm and then applies pressure to the patient’s humerus in a posterior direction (towards the back).

Indication: The patient’s apprehension or pain resolves with the application of posterior pressure, indicating a positive test.

apprehension and relocation test for Glenohumeral Instability

Labral Tears

Crank Test:

Use this test to assess labral tears.

Procedure: To perform the test, the physical therapist asks the patient to sit with their arm hanging down by their side. The examiner then applies a combination of abduction, external rotation, and extension to the patient’s arm. Passively abducts the patient’s arm to 90 degrees and externally rotates the arm. The examiner then applies a downward force on the patient’s humerus while the patient resists.

Indication: Pain in the shoulder with the downward force indicates a positive crank test. The stretching or tearing of the labrum causes this pain.

O’Brien’s Test (Active Compression Test):

Healthcare providers also use this test to assess labral tears.

Procedure: To perform the test, the healthcare provider asks the patient to sit with their arm at their side, flexing the elbow at 90 degrees and supinating the forearm (palm facing up). The examiner then applies a downward force on the patient’s humerus while the patient resists.

Indication: Pain in the shoulder indicates a positive test.

Both the crank test and the O’Brien test are relatively sensitive and specific tests for diagnosing a SLAP lesion.

special test for labral tear

Biceps Tendon Pathology special tests

Speed’s Test:

The healthcare provider use this shoulder special test to assess the  biceps tendon pathology.

Procedure: To perform the test, the healthcare provider asks the patient to actively supinate (turn outward) their forearm against resistance.

Indication: Pain in the biceps tendon indicates a positive test.

Yergason’s Test:

Healthcare providers use this test to assess the pathology of the biceps tendons.

Procedure: Similar to the Speed’s Test, the healthcare provider asks the patient to flex (bend) their elbow against resistance.

Indication: Pain in the biceps tendon indicates a positive test.

speed test, yergasons test  special tests for bicep tendon pathology

It is important to note that shoulder special tests are not always accurate. A negative test does not rule out the presence of a shoulder pathology, and a positive test does not confirm the presence of a shoulder pathology. Shoulder Special tests should be used in conjunction with the patient’s history and physical examination findings to make a diagnosis.

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