SHOULDER EVALUATIONPart 4

Special Tests (13)

Biceps tendon tests (6) Impingement tests (3) Thoracic outlet tests (4)

Yeargason Test (LH biceps): Examiner begins by positioning the standing

pt into 90 degrees of elbow flexion with the arm at the side

Examiner uses one hand to palpate the long head of the biceps and the other at the distal arm to provide resistance

Examiner then instructs pt to attempt to first externally then internally rotate the shoulder as the examiner resists the movement

Test is positive for biceps tendon subluxation (and subsequent tenosynovitis) if pt experiences pain or the examiner notes palpable crepitus.  

Gilcrest Test (LH biceps): Pt begins by grasping a 5-pound dumbbell in

each hand Pt is then instructed to externally rotate the

shoulder, supinate the wrist, and raise both arms over head

Pain or crepitus at or around the superior glenoid fossa is a positive test that is indicative of tenosynovitis of the long head of the biceps

Pain or crepitus at or around the coracoid process is a positive test that is indicative of tendinitis of the short head of the biceps

Important distinction between long head tenosynovitis and short head tendinitis lies in the fact that only the long head is protected by a tendon sheath

Speed’s Sign (LH biceps):

Examiner first palpates the tendon of the long head of the biceps (deep in the anterior deltoid)

Examiner then instructs pt to flex the elbow as the examiner resists

Pain indicates a positive sign for bicepital tenosynovitis

Lippman’s Test (LH biceps): Pt begins with the elbow

flexed to 90 degrees and the humerus resting at the side

Examiner palpates the long head of the biceps and moves 3 inches distally

Examiner then rolls the biceps tendon against the humerus

Pain indicates a positive test for long head biceps tendon subluxation

Booth & Marvel (Transv. Hum. Lig.) Test (LH biceps): Examiner passively abducts pt’s arm to 90

degrees and then passively internally and externally rotates pt’s shoulder

At the same time, the examiner maintains pressure on pt’s bicepital groove

Pain or a popping sound or sensation is indicative of a positive test for long head biceps tendon subluxation

Ludington’s Test (LH biceps): Examiner

instructs pt to clasp the hands overhead and contract the biceps isometrically

Test is positive for long head biceps tendon subluxation if pt experiences sharp pain on contraction

Neer Impingement Test (impingement): Examiner passively flexes pt’s arm

into complete flexion Pain indicates a positive test for

subacromial impingement syndrome

Hawkins-Kennedy Test (impingement): Examiner passively positions pt’s

shoulder in 90 degrees of flexion, 90 degrees of elbow flexion, and end-range shoulder internal rotation

Apprehension or sensations of pain are considered a positive test for subacromial impingement syndrome

Jam Test (impingement):

Examiner first abducts the standing pt’s arm to 90 degrees and flexes the elbow to 90 degrees

Examiner then internally rotates pt’s arm so that pt’s hand points toward the floor

Next, examiner rapidly and sharply pushes the pt’s elbow with one hand to effectively drive the greater tuberosity under the coracoacromial ligament

Examiner’s other hand should be used to stabilize the shoulder

Test is positive for subacromial impingement syndrome if pt experiences pain

Adson Test (thoracic outlet syndrome): Examiner begins by palpating pt’s

radial pulse Pt’s arm is then abducted, extended,

and externally rotated while the examiner continues to palpate the pulse

Pt is then instructed to take a deep breath and turn the head toward the arm being tested

A disappearance of the radial pulse is a positive test that indicates a compression of the subclavian artery by the medial scalene muscle

Allen Test (thoracic outlet syndrome): Pt begins from a standing position Examiner passively flexes pt’s elbow

to 90 degrees, then abducts and externally rotates pt’s shoulder

Examiner then palpates pt’s radial pulse and instructs pt to look away from the side being tested

A disappearance of the radial pulse indicates a positive test for thoracic outlet syndrome

Halstead Maneuver (thoracic outlet syndrome): The examiner first palpates pt’s

radial pulse and applies a downward traction on the pt’s arm being tested

Examiner then instructs pt to rotate the head to the opposite side and then extend the neck and look at the ceiling

A disappearance of the radial pulse indicates a positive test for thoracic outlet syndrome

Provocative Elevation (Roos) Test (thoracic outlet syndrome): Examiner instructs pt to raise both

hands overhead and rapidly pump the hands 15-30 times

Test is positive for vascular insufficiency indicating thoracic outlet syndrome if the pt experiences numbness, cramping, or tingling