Shoulder Special Tests. External Impingement Neer’s Hawkins Kennedy Empty Can Test

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

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, 10-15 ° 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