DEPARTMENT OF ORTHOPAEDICS

KMC,MANGALORE
SHOULDER EXAMINATION PART-I
Moderators Presenter
Pro:PUMANANDA MALL!A Dr:SHA"IPK
Dr:MA!UR RAI ON #$%&'%#&(&
S)e*+a, tests
Depending up on the history some of the tests are compulsory, and others may
be used as confirming or excluding tests.Results are more likely to be positive
in the presence of pathology when the muscles are relaxed,the patient is
supported and there is minimal or no muscle spasm.
Tests -or anter+or s.o/,der +nsta0+,+t1
Load and s.+-t test:
To test primarily atraumatic instability problems of the gleno humeral
joints.humerous should be centererd! in the glenoid labrum to begin.done in
sitting position.examiner shifts humerus anteriorly and posteriorly.examiner
noting the amount of translation and end feel. Differences between affected and
normal sides should be compared
.
A))re.ens+on2*ran34 test:
"rimarily to test for traumatic instability .abduct the arm #$% and laterally rotate
the shoulder slowly.a positive test is indicated by look or feeling of
apprehension or alarm on patients face.

F/,*r/5 test:
&y placing a hand under the gleno humeral joint,the apprehension test becomes
fulcrum test,pushing the head of humerus anteriorly.

Fo6,ers s+7n%test or 8o0e re,o*at+on test.:
"erform the crank test then applies a posterior translational stress to the head of
the humerus the patient will commonly lose the apprehension,any pain that is
present is commonly decreases and further lateral rotation is possible before the
apprehension or pain returns.
'nferences:
(.if symptoms decreases or eliminated when doing the relocation test)
glenohumeral instability,subluxation,dislocation or impigment.
*.if apprehension predominates during crank test and disappears with relocation
test +gleno humear joint instability or subluxation or dislocation.
,.if pain predominates when doing crank test and disappears with relocation test
anterior instability with secondary impigment.
"atients with primary impigment will show no change in their pain
with relocation test
.
Anter+or dra6er test o- t.e s.o/,der:
The patient lies supine.examiner places the hand of the affected shoulder in the
examiners axilla,holding the patients hand with arm.-houlder is abducted
between .$% and (*$%.forward flexion up to *$% and laterally rotate up to
,$%.stabilise the scapula with index and middle fingers.examiners thumb exerts
counter pressure on the patients coronoid process, then draws the humerus
forward.this movements may accompanied by a click or apprehension or both.
D/7as test:
/sed if an unredused anterior shoulder dislocation is suspected."tient is asked
to place the hand on the opposite shoulder and then attempt to lower the lower
the elbow to the chest.This is not possible with anterior dislocation.
Test -or )oster+or s.o/,der +nsta0+,+t1
Load and s.+-t test:
Poster+or a))re.ens+on test:
"osision)supine or sitting
The examiner elevates the patients shoulder in the line of scapula to #$% and
stabilise the scapula with other hand.applies posterior force on patients
elbow.while applying axial load examiner hori0ontally abducts and medially
rotates the arm.positive results)a look of apprehension or alarm on the patients
face and the patients resistance to further further motion.
P/,, )/s. test:
"osition) supine
1old the patients arm at wrist,abducts the arm #$%,forward flexion ,$%."laces
the other hand over the humerus close to the humeral head.2xaminer pulls up on
the arm at wrist while pushing down the humerus with the other hand.3ore than
4$5 transolocation or if the patients becomes apprehensive or pain)posterior
instability.

"er3 test:
"atient sits with arm medially rotated and forward flexed to #$%,examiner
grasps patient elbow and axially loads the humerus in proximal direction.6hile
maintaining the axial loading examiner moves the arm hori0ontally across the
body.sudden jerk or clunk as humeral head slides off, followed by a second jerk
while the arm is returned to original #$% abduction position)positive test.

Test -or +n-er+or s.o/,der +nsta0+,+t1
S/,*/s s+7n:
The patient stands with the arm by the side and shoulder muscles relaxed.
2xaminer grasps the patients forearm below the elbow ad pulls the arm distally.
The presence of sulcus sign may indicative of inferior instability or
glenohumeral laxity.

Tests -or +5)+n7e5ent
7nterior shoulder impingement regadless of its cause8 rotator cuff pathology,
bicipital paratenonitis9tendinosis,scapular or humeral instability,labral
pathology: is results of structures being compressed in the anterior aspects of
the humerus between the head of humerus and coracoid process under the
acromion process.
Neer +5)+n7e5ent s+7n:
7rm is passively ; forcibly fully elevated in the scapular plane with the arm
medially rotated by examiner.This passive stress causes jamming! of the
greater tuberosity against the anteroinferior border of the acromion.patients face
shows pain)positive results8over use injury to supraspinatus muscle and
sometimes to the biceps tendon: .<eer also described the impingement test with
the use of a subacromial injection of ($ m= of (5 lidocaine 8>ylocaine:. "ain
caused by impingement usually is significantly reduced or eliminated, but pain
caused by other conditions 8with the exception perhaps of calcific tendinitis: is
not relieved.

Ha63+n7s-3enned1 +5)+n7e5ent test:
1awkins and ?ennedy described their test in (#.$ as an alternative to the <eer
test, but they did not believe that it was as reliable The test is performed by
forward flexing the humerus to #$ degrees and forcibly internally rotating the
shoulder. This maneuver drives the greater tuberosity farther under the
coracoacromial ligament, reproducing the impingement pain.this movement
pushes supraspinatus tendon against anterior surface of coracoacromio
ligament and coracoids process
.
Re9erse +5)+n7e5ent s+7n:
Test doing if a patient has a positive painful arc or pain on lateral rotation.test
can be done in supine,standing ; with forward flexion of shoulder.2xaminer
pushes the head of humerus inferiorly as the arm is abducted or laterally
rotated.'f the pain decreases during this test ,can be taken as positive.
.
Test -or ,a0ra, tears
C,/n3 test
6hile performing rowe test8anterior instability: if a clunk sound is
getting,positive for labral tears.
Anter+or s,+de test2SLAP ,es+ons4
"atient is sitting with hands on waist,thumbs posterior@examiner stands behind
and stabilises scapula and clavicle with one hand.6ith other hand examiner
applies an anterosuperior force at elbow.The humeral head slides over labrum
with a pop or crack and patient complains of anterosuperior pain.
A*t+9e *o5)ress+on test o- O:;r+en2SLAP4
"atient in standing position with arm forward flexed to #$%,elbow is fully
extended.The arm is then hori0ondally rotated ($% to (4% and medially rotate so
the tumb faces downward,apply downward force.The arm is returned to the
starting position and the palm is supinated and downward eccentric load is
repeated.'f painfull click or pain is produced inside the shoulder8not over the
7A joint: in the (
st
part and eliminates or decreases in the second part the test is
considered positive.
Co5)ress+on rotat+on test:
"atient lies supine position,the examiner grasps the arm abducted *$%.push or
compress in the glenoid,with other hand rotate the humerus medially and
laterally.snapping or catching sensation)test is positive for labral tear8bankart or
-=7" lesion:.
Ot.er s.o/,der 8o+nt tests
A*ro5+o *,a9+*/,ar s.ear test:
"osition)sitting.2xaminer cups hands over deltoid muscle, with one hand on the
clavicle and one hand on the spine of scapula.2xaminer then sBeeses the heels
of the hands together."ain or abnormal movement at the 7A joint)7A joint
pathology.
A*ro5+o *,a9+*/,ar *rosso9er,*ross0od1,or .or+<onta, add/*t+on test:
Corward flexion of arm to #$% then hori0ontally adducts the arm as far as
possible.
=ocalised pain at 7A joint)7A joint pathology
=ocalised pain at sternoclavicular joint)pathology at this joint
Tests -or ,+7a5ents
Cran3 test:
Arank test may also be used as a test for different glenohumeral ligaments.
7rm by side )superior glenohumeral ligaments
)capsule

D4)E$% abduction)middle glenohumeral ligament
)coracohumeral ligament
)inferior glenohumeral ligament8anterior band:
)anterior capsule
Fver #$% abduction)inferior glenohumeral ligament
)anterior capsule
Test -or 5/s*,e or tendon )at.o,o71
S)eed Test2stra+7.t ar5 test4:
'n (#EE, Arenshaw and ?ilgore described a test they attributed to -peed.
Corward flex the shoulder to #$ degrees with the elbow extended and the
forearm supinated. Resistance is applied to the forearm, and a positive result
produces pain locali0ed to the 0+*+)+ta, groove in case of bicipital paratenonitis
and tendinosis.

!er7ason test:
Gergason described the supination sign! in (#,(.this test is primarily designed
to test the ability of the transverse humeral ligament to hold the biceps tendon in
the bicipital groove.The elbow is flexed to #$ degrees, and the forearm is
pronated. The patient attempts to supinate the forearm actively against
resistance applied by the examiner at the patientHs wrist. "ain locali0ed to the
bicipital groove indicates inflammation of the long head of the 0+*e)s.

E5)t1 *an test:
The patients arm is abducted to #$% with neutral rotation. Resistance to
abduction is provided by the examiner.the shoulder is then medially rotated and
angled forward ,$%8empty can position:. -o that patients thumb pointed
towards the floor in the plane of scapula. Resistance to abduction is again given
while the examiner looks for weakness or pain. "ositive test result indicates a
tear of the s/)ras)+nat/s tendon or muscle or neuropathy of suprascapular
nerve.

Dro)-ar52*od5an:s4 test:
2xaminer abducts patients shoulder to #$% and then asks the patient to slowly
lower the arm to side in the same arc movement. "ositive test)unable to return
the arm to the side slowly or has severe pain when attempting to do so ,which
indicates tear in the rotator */--.

L+-t-o-- Test:
'n (##(, Ierber and ?rushell described the lift)off test for detection of an
isolated rupture of the s/0s*a)/,ar+s tendon .6ith the patient seated or
standing, the arm is internally rotated, and the dorsum of the hand is placed
against the lower back. 'f the patient is unable to lift the dorsum of the hand off
the back, the test is positive. 7bnormal movements of scapula during the test
may indicate)scapular instability
.
;e,,1 Press Test:
The patient presses the abdomen with the flat of the hand and attempts to keep
the arm in maximal internal rotation. 'f active internal rotation is strong, the
elbow does not drop backward, 'f the strength of the subscapularis is impaired,
maximal internal rotation cannot be maintained, the patient feels weakness, and
the elbow drops back behind the trunk. The patient exerts pressure on the
abdomen by extending the shoulder, rather than by internally rotating it. Fther
investigators have noted that when the subscapularis tendon is torn, patients
tend to flex the wrist to press against the abdomen and are unable to hold the
elbow forward.

Re-eren*es
(:disorders of shoulder diagnosis and management)Joseph.".'nnotti,Ierrald.R.6illiams@*
nd
edition.volume ',page no 4,)($(
*:rockwood and masten,The shoulder.*
nd
edition,volume '.page no (ED)(#E
,:Rockwood and greens fracture in adult@K
th
edition,page no ((E4)(*($.
D:Aampbells operative orthopaedics volume '''. ((
th
edition.page no *E$,)*E,D.