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GHJ Special Tests
| Question | Answer |
|---|---|
| Yergason's test purpose | test the integrity of the transverse ligament |
| Yergason's test description | Pt sit with elbow flex 90 degrees and stabilized against thorax and with the forearm pronated. Resist the supination of forearm and ER of the shoulder |
| Yergason's test results | Tendon of long head of biceps will pop out of groove. Tenderness in bicipital groove alone with dislocation may indicate bicipital Paratenonitis/tendinosis |
| Speed's test purpose | identify bicipital tendinosis/tendinopathy |
| speed's test description | upper limb in full extension and forearm supinated, resist shoulder flexion. Alternate - place shoulder in 90 degree of flexion and push upper limb into extension |
| speed's test results | pain in long head of biceps tendon/ increased tenderness in the bicipital groove |
| Neer's impingement test purpose | for impingement of supraspinatus and biceps tendon |
| Neer's impingement test description | pt's arm is passively and forcibly fully elevated in the scapular plan with the arm medially rotated. This passive stress causes the greater tuberosity to jam into the anteroinferior border of the acromion |
| Neer's impingement result | reproduces symptoms of pain in the shoulder region |
| Empy can/ JOBE test purpose | identify tear/impingement of supraspinatus tendon or suprascapular nerve neuropathy |
| Empty Can/ JOBE test description | pt's arm is abd to 90 with neutral rotation, and examiner provides resistance to abduction. Shoulder is ten IR and angled 30 degrees so pt's thumb points to the floor in the plane of the scap. Differentiate if pain is present between two positions. |
| Empty can/ JOBE test result | reproduces pain in supraspinatus tendon or weakness in empty can position |
| Drop arm test / Codman's test purpose | identify tear/full rupture of the rotator cuff |
| Drop arm test / Codman's test description | examiner abducts the pt's shoulder to 90 and then asks pt to slowly lower the arm to the side in the same arc of motion |
| Drop arm test / Codman's test results | positive test indicated if the pt is unable to return the arm to the side slowly or has severe pain when attempting to do so. |
| Posterior internal impingement test purpose | to identify impingement between rotator cuff and greater tuberosity or posterior glenoid and labrum |
| posterior internal impingement test description | Pt lays supine. Examiner passively abducts the shoulder to 90-110 degrees, with 15-20 degrees extension and maximal lateral rotation |
| posterior internal impingement test results | reproduction of posterior shoulder pain during test |
| Hawkins-Kennedy impingement test purpose | identify subacromial impingement |
| Hawkins-Kennedy impingement test description | pt's arm is passively flexed up to 90 degrees in plan of scapula. The arm is stabilized and the forearm is forced into IR |
| Hawkins-Kennedy impingement test result | Pain indicates positive test for supraspinatus paratenonitis/tendinosis or secondary impingement |
| Yocum test | modification of Hawkins-Kennedy impingement test in which the pt's hand is placed on the opposite shoulder and the examiner elevates the elbow |
| Horn Blower's sign (Patte test) purpose | to detect rotator cuff tears involving the teres minor |
| Horn Blower's sign (Patte test) description | Pt sitting/standing. Pt's arm is supported at 90 degrees of abduction in scapular plane, with elbow flexed to 90. Pt is then asked to rotate the forearm externally against resistance of the clinician's hands |
| Horn Blower's sign (Patte test) results | if unable to ER the shoulder in this position |
| Active compression test of O'brien purpose | To detect SLAP (type 2) or superior labral lesions |
| Active compression test of O'brien description | 2 parts. pt stands with involved shoulder at 90 flexion, 10 degrees hor add, and max IR with elbow in extension. Pt then resists a downward force applied by clinical to distal arm. Test is repeated in same manner but in max ER |
| Active compression test of O'brien results | pain on joint line of painful clicking produced inside the shoulder (not over the AC joint) in first part of the test and eliminated/decreased in 2nd, the test is positive for labral abnormalities |
| Biceps load test purpose | Check the integrity of the superior labrum |
| Biceps load test description | Shoulder abducted 120, ER, elbow flexed to 90, forearm supinated. Examiners performs an apprehension test on pt by taking arm into full ER. Pt then flexes elbow against examiner's resistance at the wrist. |
| Biceps load test results | apprehension decreases or pt feels more comfortable: test is negative. Apprehension remains or shoulder becomes more painful, positive for SLAP lesion |
| Lateral Rotation Lag sign (infraspinatus "spring back" test) purpose | Test teres minor and infraspinatus |
| Lateral Rotation Lag sign (infraspinatus "spring back" test) description | Pt seated/stand with arm by side and elbow flexed 90. Examiner passively abducts to 90 in scapular plane, ER shoulder to end range, and asks pt to hold it |
| Lateral Rotation Lag sign (infraspinatus "spring back" test) results | Positive: cannot hold the position and the hand springs back anterior toward midline indicates infraspinatus and teres minor cannot hold the position due to weakness |
| Abdominal Compression test (Belly press or napoleon test) purpose | Checks the subscapularis muscle |
| Abdominal Compression test (Belly press or napoleon test) description | Examiner places hand on pt's abdomen to feel how much pression applied to the abdomen. Pt places his hand of the shoulder being test on examiners hand and pushes as hard as he can into the stomach (IR) while bringing the elbow forward to the scap plane |
| Abdominal Compression test (Belly press or napoleon test) results | If unable to maintain pressure on examiner's hand while moving the elbow forward, of posterior flexes the wrist or extends the shoulder, the test is positive for a tear of the subscapularis muscle. |
| Lift off sign (Gerber's test) purpose | detect a lesion of the subscapularis muscle |
| Lift off sign (Gerber's test) description | Pt places dorsum of hand on back pocket or against the mid-lumbar spine. (Great subscap activity with 2nd position) pt then lifts the hand away from the back |
| Lift off sign (Gerber's test) result | inability indicates lesion of subscap muscle |
| Jerk Test purpose | test recurrent posterior instability |
| Jerk Test description | pt sits with arm flexed to 90 and IR. Examiner grasps pt's elbow and axially load the humerus in a proximal direction. While maintaining axial loading, the examiner moves arm horizontally across the body |
| Jerk Test results | Positive test is production of sudden jerk or clunk as the humeral head slides off (subluxes) the back of glenoid. When the arm is returned to original 90 abd, second jerk may be felt as head reduces |
| Sulcus sign purpose | test for inferior shoulder instability |
| Sulcus sign description | Pt stands with arm by the side and shoulder muscles relaxed. Examiner rasps the pt's forearm below the elbow and pulls the arm distally. |
| Sulcus sign result | indicates inferior instability or glenohumeral laxity but should only be considered positive if pt is symptomatic |
| Pectoralis major contraction test purpose | to identify tightness of pec major muscle |
| Pectoralis major contraction test description | pt is supine and clasps hands together behind the head. Arms are then lowed until the elbows touch the examining table |
| Pectoralis major contraction test result | positive occurs if elbows do not reach the table and indicates a tight pec Major muscle |
| Halstead maneuver purpose | Identify pathology of structures that pass through the thoracic inlet |
| Halstead maneuver description | Examiner finds the radial pulse and applies a downward traction on test extremity while pt is hyperextended and rotated to the opposite side |
| Halstead maneuver result | absence of disappearance of pulse indicates positive test for TOS |
| Clunk test purpose | identifies glenoid labrum tear |
| Clunk test description | Pt is supine with should in full abduction. Push the humeral head anteriorly while rotating humerus externally |
| Clunk test result | audible clunk |
| Anterior apprehension/Crank test purpose | identify past anterior dislocation of shoulder |
| Anterior apprehension/Crank test description | Pt supine, examiner abd arm to 90 and ER the shoulder slowly. By placing hand under the GHJ to act as fulcrum, the test becomes a fulcrum test |
| Anterior apprehension/Crank test result | Pt doesn't allow or doesn't like to move the shoulder into that direction to stimulate the anterior dislocation |
| Posterior apprehension sign purpose | Identify past history of posterior shoulder dislocation |
| Posterior apprehension sign description | Pt supine/sitting. Examiner elevates the shoulder in place of scap to 90 while stabilizing the scapula with the other hand. then applies a posterior force on patient's elbow. While applying axial load, examiner horizontally adducts and IR arm |
| Posterior apprehension sign result | Pt doesn't allow or doesn't like to move the shoulder into that direction to stimulate posterior dislocation |
| acromioclavicular shear test purpose | Identifies dysfunction of AC joint such as arthritis, separation |
| acromioclavicular shear test description | Pt sitting. Examiner cups their hands over deltoid with one hand on clavicle and one hand on spine of scapula. Examiner then squeezes the heel of the hands together |
| acromioclavicular shear test results | reproduces pain at the AC joint |
| Adson's test purpose | identify pathology of structures that pass through the thoracic inlet |
| Adson's test description | Examiner locates the radial pulse. Pt's head is rotated to face the test shoulder. Pt extends the head while examiner ER and extends the shoulder. Pt is instructed to take a deep breath and hold it |
| Adson's test results | Disappearance of the pulse indicates a positive test |
| Costoclavicular Syndrome (military brace) purpose | identify pathology of structures that pass through thoracic inlet |
| Costoclavicular Syndrome (military brace) description | The examiner palpates the radial pulse and then draws he patient's shoulder down and back |
| Costoclavicular Syndrome (military brace) results | Positive test indicated by absence of pulse and implies possible thoracic outlet syndrome (costoclavicular syndrome). Test is particularly effective in patients who complain of symptoms while wearing a heavy backpack of heavy coat. |
| Wright (hyperabduction) test purpose | identify pathology of structures that pass through thoracic inlet |
| Wright (hyperabduction) test description | patient siting, locate radial pulse of extremity being tested. Move the shoulder into maximum abduction and ER. Taking a deep breath and rotating the head opposite to test site may accentuate symptoms |
| Wright (hyperabduction) test results | neurological/ vascular symptoms (disappearance of pulse) reproduced |
| Roos test (elevated arm stress test) purpose | identify pathology of structures that pass through thoracic inlet |
| Roos test (elevated arm stress test) description | Pt stands and abducts arms at 90, ER the shoulder, and flexes the elbow to 90 so elbows are slightly behind the frontal plane. The pt then opens and closes the hands slowly for 3 min. |
| Roos test (elevated arm stress test) results | If pt unable to keep the arms in starting position for 3 min or suffers ischemic pain, heaviness or profound weakness of the arm, or numbness and tingling of the hand during the minutes, the test is considered positive for TOS on the affected side |
| ULNT1 description | shoulder is depressed and abd (110). Elbow is extended. Forearm supinated, wrist extended. Fingers and thumb in extension. C/S contrlateral flexion. |
| ULNT1 nerve bias | Median nerve, anterior interosseous nerve, C5,C6, C7 |
| ULNT2 description | Shoulder depressed and abducted (10), elbow extended, forearm supinated, wrist extended, fingers and thumb extended. Shoulder ER. C/S contralateral side flexion. |
| ULNT2 nerve bias | Median nerve, musculocutaneous nerve, axillary nerve |
| ULNT3 description | shoulder depression, IR, abd (40), and extension (25). Forearm pronated. Wrist flexion and ulnar deviation. Fingers and thumb flexion. C/S contralateral side flexion. |
| ULNT3 nerve bias | radial nerve |
| ULNT4 description | Sh depression and abd (10-90), hand to ear. Elbow flexion. Forearm supination or pronation,. Wrist extension and radial deviation. Fingers and thumbs extension. Sh lateral rotation. C/S contralateral side flexion |
| ULNT4 nerve bias | Ulnar nerve, C8 ant T1 nerve roots |
Created by:
ecosio
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