stabilizes the scapula and applies a posteriorly directed force to the humeral head
Patient: resists force
Positive test: reproduction of pain in the subacromial space
Consistent with: subacromial impingement
Negative test: no pain reproduced
Rules out: subacromial impingement
Alternative diagnosis: other shoulder pathology may still be present
stabilizes the scapula and applies a posteriorly directed force to the humeral head
Patient: resists force
Positive test: reproduction of pain in the subacromial space
Consistent with: subacromial impingement
Negative test: no pain reproduced
Rules out: subacromial impingement
Alternative diagnosis: other shoulder pathology may still be present
stabilizes the scapula and applies a posteriorly directed force to the humeral head
Patient: resists force
Positive test: reproduction of pain in the subacromial space
Consistent with: subacromial impingement
Negative test: no pain reproduced
Rules out: subacromial impingement
Alternative diagnosis: other shoulder pathology may still be present
C111 11 875 Nurul Insyira C111 11 869 St. Nursyamsiah C 111 11 174 Advisors: dr. Alfa Januar dr. Ery Wildan dr. Michael Benjamin
Supervisor: dr. A. DHEDIE PRASETYA, M.KES, SP.OT
ORTHOPEDIC AND TRAUMATOLOGY DEPARTMENT
HASANUDDIN UNIVERSITY PHYSICAL EXAMINATION OF THE SHOULDER ANATOMY ANATOMY ANATOMY Physical Examination of the Shoulder
LOOK FEEL MOVE SPECIAL TESTS LOOK
Examine as soon as patient entering the
examination room: • Arm support (protection of shoulder) • Swinging • Swelling, asymmetry, muscle atrophy and scars FEEL (anterior view) FEEL (posterior view) FEEL (lateral view) MOVE SPECIAL TESTS Drop Arm Test Resisted External Rotation Resisted Internal Rotation Empty Can Test Liftoff Test Hawkin’s Test Neer’s Test Cross Arm/Adduction/Appley’s Scarf Test Speed Test Yergason’s Test O’Brien Test Apprehension Test Relocation Test Surprise Test (Anterior Release) Belly Press Test SPECIAL TESTS Drop Arm Test Resisted External Rotation Resisted Internal Rotation Belly Press Test Liftoff Test Empty Can Test Hawkin’s Test Neer’s Test Cross Arm/Adduction/ Appley’s Scarf Test O’Brien Test Speed Test Yergason’s Test Apprehension Test Relocation Test Patient : Sit or stand Surprise Test Examiner : Abduct arm to 90° in the coronal plane then (Anterior Release) horizontally adduct to 45° and ask patient to slowly lower arm Positive test: Severe pain, or patient unable to lower arm in a controlled manner on affected side Consisten with: Rotator cuff tear or significant tendinopathy SPECIAL TESTS Drop Arm Test Resisted External Rotation Resisted Internal Rotation Belly Press Test Empty Can Test Liftoff Test Hawkin’s Test Neer’s Test Cross Arm/Adduction/ Appley’s Scarf Test Speed Test Yergason’s Test O’Brien Test Apprehension Test Relocation Test Surprise Test Patient: begins sitted with elbow at side and flexed to 90°. (Anterior Release) Patient actively externally rotates shoulder Examiner : stand at side and actively resist external rotation Positive test: patient has weakness and/or pain on affected side Consisten with: Rotator cuff or posterior deltoid disfunction SPECIAL TESTS Drop Arm Test Resisted External Rotation Resisted Internal Rotation Belly Press Test Empty Can Test Liftoff Test Hawkin’s Test Neer’s Test Cross Arm/Adduction/ Appley’s Scarf Test Speed Test Yergason’s Test O’Brien Test Apprehension Test Patient : sits, elbows at sides, elbow flexed, actively internally Relocation Test rotates shoulder. Surprise Test (Anterior Release) Examiner : stand at side and actively resist internal rotation at distal forearm Positive test: patient has weakness and/or pain on affected side Consistent with: Rotator cuff tendinopathy and/or subscapularis disfunction SPECIAL TESTS Drop Arm Test Resisted External Rotation Resisted Internal Rotation Belly Press Test Liftoff Test Empty Can Test Hawkin’s Test Neer’s Test Cross Arm/Adduction/ Appley’s Scarf Test O’Brien Test Speed Test Patient : Patient’s palm against the abdomen, with the arm in the Yergason’s Test Apprehension Test coronal plane and the elbow flexed to 90° Relocation Test Examiner : Examiner’s hand is pleased between the patient’s hand and Surprise Test abdomen, so that the strength of the subsequent pressure can be felt. (Anterior Release) The patient is then instructed to press the hand firmly against the abdomen. Positive test: The pressure will be weak and the patient will often move the elbow forward from the coronal plane in an attempt to gain more leverage Consistent with: significant subscapularis weakness SPECIAL TESTS Drop Arm Test Resisted External Rotation Resisted Internal Rotation Belly Press Test Liftoff Test Empty Can Test Hawkin’s Test Neer’s Test Cross Arm/Adduction/ Appley’s Scarf Test O’Brien Test Speed Test Yergason’s Test Patient : stands or lies prone, the arm is internally rotated and Apprehension Test Relocation Test elbow is moderately flexed, with the dorsum of the and touching Surprise Test the mid-lumbar spine (Anterior Release) Examiner : instruc patient to lift the hand away from the back Positive test: inability to lift the dorsum of the hand off the back again gravity or minimal resistant from examiner, or restriction is noted compared with contralateral side Consistent with: weakness of the subscapularis, latissimus dorsi, or rhomboids SPECIAL TESTS Drop Arm Test Resisted External Rotation Resisted Internal Rotation Belly Press Test Liftoff Test Empty Can Test Hawkin’s Test Neer’s Test Cross Arm/Adduction/ Appley’s Scarf Test O’Brien Test Speed Test Yergason’s Test Apprehension Test Patient : shoulders abducted to 90° and angled forward 30°, Relocation Test elbows fully extended, and forearms fully pronated (thumbs Surprise Test down as if turning a can upside down) (Anterior Release) Examiner : apply downward force to the patient distal forearm, while patient attempt to resist. Positive test: patient shoulder pain is reproduced Consistent with: Supraspinatus tendinopathy SPECIAL TESTS Drop Arm Test Resisted External Rotation Resisted Internal Rotation Belly Press Test Liftoff Test Empty Can Test Hawkin’s Test Neer’s Test Cross Arm/Adduction/ Appley’s Scarf Test O’Brien Test Speed Test Yergason’s Test Patient : flexes elbow and shoulder to 90° withy shoulder Apprehension Test Relocation Test internally rotated such that the fist is down. Surprise Test Examiner : stabilize the patient’s arm by holding proximal to (Anterior Release) the elbow while applying tension on the anterior distal forearm to maximally internally rotate the shoulder Positive test: reproduces patient’s shoulder pain in the area of the acromion Consistent with: impingement syndrome SPECIAL TESTS Drop Arm Test Resisted External Rotation Resisted Internal Rotation Belly Press Test Liftoff Test Empty Can Test Hawkin’s Test Neer’s Test Cross Arm/Adduction/ Appley’s Scarf Test O’Brien Test Speed Test Yergason’s Test Apprehension Test Relocation Test Surprise Test Patient : extends elbow and pronates forearm (thumbs down) (Anterior Release) Examiner : lift the patient’s arm in flexion and 30° in the coronal plane, passively extending the shoulder to end range. Positive test: patient’ shoulder pain is reproduced Consistent with: impingement syndrome SPECIAL TESTS Drop Arm Test Resisted External Rotation Resisted Internal Rotation Belly Press Test Liftoff Test Empty Can Test Hawkin’s Test Neer’s Test Cross Arm/Adduction/ Appley’s Scarf Test O’Brien Test Speed Test Yergason’s Test Apprehension Test Relocation Test Patient : sits or stands Surprise Test Examiner : flexed shoulder to 90° and bring arm horizontally (Anterior Release) acrossed the chest so the arm is moved towards the contralateral shoulder. The examiner feels the ipsilateral acromioclavicular (AC) joint . Positive test: pain, shifting, or a click at the AC joint Consistent with: acromioclavicular dysfunction SPECIAL TESTS Drop Arm Test Resisted External Rotation Resisted Internal Rotation Belly Press Test Liftoff Test Empty Can Test Hawkin’s Test Neer’s Test Cross Arm/Adduction/ Appley’s Scarf Test O’Brien Test Speed Test Yergason’s Test Patient : positions upper limb with shoulder flexed to 90°, horizontally adducted Apprehension Test to 15° and maximally internally rotated and elbow fully extended Relocation Test Examiner : Surprise Test 1. Apply the downward force to the distal forearm against maximal resistent of (Anterior Release) the patient 2. The above is repeated with shoulder externally rotated Positive test: pain or audible click at the acromioclavicular joint or at the glenohumeral joint Consistent with: acromioclavicular joint dysfunction if pain in AC joint, or superior labral anterior posterior (SLAP) pathology if pain at the glenohumeral joint SPECIAL TESTS Drop Arm Test Resisted External Rotation Resisted Internal Rotation Belly Press Test Liftoff Test Empty Can Test Hawkin’s Test Neer’s Test Cross Arm/Adduction/ Appley’s Scarf Test O’Brien Test Speed Test Yergason’s Test Apprehension Test Relocation Test Patient : flexes shoulder to 50°, with elbow in extension and Surprise Test wrist in supination (Anterior Release) Examiner : provide downward force on the arm to attempt to extend the patient’s shoulder Positive test: pain in the area of the bicipital tendon Consistent with: bicipital tendonitis SPECIAL TESTS Drop Arm Test Resisted External Rotation Resisted Internal Rotation Belly Press Test Liftoff Test Empty Can Test Hawkin’s Test Neer’s Test Cross Arm/Adduction/ Appley’s Scarf Test O’Brien Test Speed Test Yergason’s Test Apprehension Test Relocation Test Patient : sits on exam table or chair with the arm resting at Surprise Test (Anterior Release) side; elbow flexed to 90° and forearm pronated. Examiner : grabs patient’s forearm just proximal to the wrist and resist active supination Positive test: pain located in the bicipital groove Consistent with: bicipital tendonitis/ tendinopathy SPECIAL TESTS Drop Arm Test Resisted External Rotation Resisted Internal Rotation Belly Press Test Liftoff Test Empty Can Test Hawkin’s Test Neer’s Test Cross Arm/Adduction/ Appley’s Scarf Test O’Brien Test Speed Test Patient : Yergason’s Test 1. Lies on table, with arm hanging off edge. Apprehension Test 2. Shoulder is abducted to 90°, elbow flexed to 90°, and shoulder maximally Relocation Test externally rotated. Surprise Test Examiner : furthur externally rotate shoulder by applying posteriorly directed (Anterior Release) force on the distal forearm with one hand and anterior force on the proximal arm. Do not go beyond the patient’s pain threshold Positive test: reproduces the patient’s pain or gives the patient the “apprehension” of reproduction of their pain or the feeling that their shoulder will dislocate or “ pop out of the socket” Consistent with: anterior shoulder laxity or instability SPECIAL TESTS Drop Arm Test Resisted External Rotation Resisted Internal Rotation Belly Press Test Liftoff Test Empty Can Test Hawkin’s Test Neer’s Test Cross Arm/Adduction/ Appley’s Scarf Test O’Brien Test Speed Test Patient : Yergason’s Test 1. Lies on table, with half of arm hanging off edge. Apprehension Test 2. Shoulder is abducted to 90°, elbow flexed to 90°, and shoulder Relocation Test Surprise Test maximally externally rotated. (Anterior Release) Examiner : 1. Stabilize patient’s arm by holding the wrist 2. With the palm of the hand, direct a posterior force to the glenohumeral joint Positive test: pain and/or sense of shoulder instability decreases or the range of motion increases. Consistent with: anterior shoulder laxity or instability SPECIAL TESTS Drop Arm Test Resisted External Rotation Resisted Internal Rotation Belly Press Test Liftoff Test Empty Can Test Hawkin’s Test Neer’s Test Cross Arm/Adduction/ Appley’s Scarf Test O’Brien Test Speed Test Yergason’s Test Patient : Apprehension Test Relocation Test 1. Lies on table, with half of arm hanging off edge. Surprise Test 2. Shoulder is abducted to 90°, elbow flexed to 90°, and (Anterior Release) shoulder maximally externally rotated. Examiner : perform relocation test and then suddenly release force on glenohumeral joint Positive test: return of symptoms of pain or instability Consistent with: anterior shoulder laxity or instability THANK YOU