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MFB Shoulder Examinations Final
MFB Shoulder Examinations Final
MFB Shoulder Examinations Final
Table of Contents
Anatomy and Pathology Review3
Rotator Cuff, Shoulder/Scapular Instability, and SLAP Lesion Assessments...6
Neer Impingement Test..7
Hawkins-Kennedy Impingement Test8
Empty Can Test..9
Codmans Sign or Drop-Arm Test...10
Upper Cut Test.11
Posterior Apprehension Test or Stress Test.....12
Gerber Lift-Off Test.13
Sulcus Sign and Feagin Test (Modified Sulcus Sign)..14
Anterior Apprehension Test (Crank Test)15
SLAPprenension Test...16
Biceps Tendonitis Assessments17
Speeds Test..18
Yergasons Test........19
Thoracic Outlet Syndrome Assessments..20
Adson and Allen Maneuver Tests.21
References.22
Muscle
Supraspinatus
Infraspinatus
Teres Minor
Subscapularis
Origin
Supraspinatus fossa of
the scapula (posterior)
Infraspinatus fossa of
the scapula
Upper third of the
lateral border of the
scapula
Anterior subscapular
fossa of the scapula
(anterior)
Insertion
Superior aspect of the
greater tubercle
Medial aspect of the
greater tubercle
Inferior aspect of the
greater tubercle
Lesser tubercle &
articular capsule of the
glenohumeral joint
Action
Abduction
Horizontal abduction,
Abduction, ER
Horizontal abduction,
Abduction, ER,
Extension
Abduction, Adduction,
IR
(Magee, 1997)
SLAP tear
Superior Labrum, Anterior Posterior. SLAP tear is a tear that occurs at the biceps tendon insertion
into the superior labrum of the shoulder.
Rotator Cuff,
Shoulder/Scapular Instability,
and SLAP Lesion Assessments
Literature:
Although some practitioners prefer to administer the Neer Impingement test in external
rotation, Yamamoto et al. (2009) reported the maximum contact pressure is with internal
rotation of the arm.
van Kampen et al. (2014) reported that the Neer Test has the best overall accuracy over the
Empty Can, Hawkins-Kennedy, Drop-Arm, and Lift-Off Tests.
Subacromial impingement sensitivity: 79% and specificity: 53% for (Hegedus et al., 2008)
Subacromial bursitis sensitivity: 75% (MacDonald, Clark, & Sutherland, 2000)
Rotator cuff tear sensitivity: 85% (MacDonald, Clark, & Sutherland, 2000)
When combined with the Hawkins-Kennedy Test, the two tests exhibited a high negative
predictive value: 96% for subacromial bursitis and 90% for rotator cuff tearing
(MacDonald, Clark, & Sutherland, 2000).
Neer signs were also positive in 46% of patients with SLAP lesions (Pappas, et al., 2006).
The Neer Test is useful for ruling out subacromial impingement (Alqunaee, Galvin, &
Fahey, 2012; Michener, Walsworth, Doukas, & Murphy, 2009).
(Alqunaee, Galvin, & Fahey, 2012; Magee, 1997)
Literature:
Sensitivity: 79% and specificity: 59% for subacromial impingement (Hegedus et al., 2008)
Sensitivity: 92% for subacromial bursitis (Pappas, et al., 2006)
Hawkins-Kennedy signs were also positive in 69% of patients with SLAP lesions (Pappas,
et al., 2006)
According to Pappas et al. (2006), The Hawkins-Kennedy Test elicits substantially greater
subacromial contact of the rotator cuff than the Neer Impingement Test.
When combined with the Neer Impingement Test, the two tests exhibited a high negative
predictive value: 96% for subacromial bursitis and 90% for rotator cuff tearing
(MacDonald, Clark, & Sutherland, 2000)
The Hawkins-Kennedy Test is useful for ruling out subacromial impingement (Alqunaee,
Galvin, & Fahey, 2012)
(Alqunaee, Galvin, & Fahey, 2012; Gerber, C., Terrier, F., & Ganz, R., 1985; Hawkins, & Kennedy, 1980; & Magee, 1997)
Literature:
van Kampen et al. (2014) reported that the Empty Can Test is more sensitive (68.4%) than
the Neer, Hawkins-Kennedy, Drop-Arm, and Lift-Off.
According to Hegedus et al. (2008), the Empty Can Test may serve as a confirmatory test
for impingement due to its high specificity.
The test was 70% accurate when muscle weakness was interpreted as indicating a torn
supraspinatus tendon (Itoi et al., 1999).
The Empty Can Test is useful for ruling out subacromial impingement (Alqunaee, Galvin,
& Fahey, 2012).
According to Michener et al. (2009), The Empty Can Test is found to be useful in
confirming subacromial impingement.
(Alqunaee, Galvin, & Fahey, 2012; Magee, 1997 & Magee, 2014)
Literature:
Because of the Drop-Arms high specificity (98%), it is a predictor for rotator cuff tear.
However, the sensitivity is low (10%) (Murrell & Walton, 2001). Therefore, 98% of
patients with a positive finding have the chance of a rotator cuff tear.
van Kampen et al. (2014) reported that the Drop-Arm Test has a specificity and positive
predictive value of 100%.
According to Hegedus et al. (2008), the Drop Arm Test demonstrated value as a specific
tests for a tear of any rotator cuff muscle.
The Drop-Arm Test demonstrated high levels of diagnostic accuracy for a complete
supraspinatus tear (Cadogan et al., 2011).
The Drop-Arm Test is more useful for ruling in Subacromial Impingement Syndrome (SIS)
if the test is positive (Alqunaee, Galvin, & Fahey, 2012).
10
Literature:
Biceps tendon injury sensitivity: 73%, specificity: 78%, and accuracy: 77%.
Kibler et al. (2009) reported that the Upper Cut was the most accurate in detecting biceps
tendon injury and produced the highest positive likelihood ratio amongst other tests
(Speeds, Yergasons, and five other biceps tendon tests that are not listed in this report).
Labral injury sensitivity: 22%, Specificity: 56%, and accuracy: 32%
This is a newer test, which requires further research
11
Literature:
Sensitivity: 19.2%, specificity: 99.2%, and Likelihood ratio: 24.97%
PubMed, ProQuest Medical Library, and CINAHL Complete were searched with the
search terms Posterior Apprehension Test and Posterior Stress Test with no peerreviewed publications indicative of the test.
12
Literature:
According to Gerber and Krushell (1991), the Lift-Off Test is highly reliable in detecting
subscapularis rupture.
Greis et al. (1996) concluded that the Lift-Off maneuver effectively isolated the
subscapularis muscle, indicating that the Lift-Off test is valid and specific for evaluation of
the subscapularis (Tokish et al., 2003).
The Lift-Off Test is more useful for ruling in Subacromial Impingement Syndrome (SIS) if
the test is positive (Alqunaee, Galvin, & Fahey, 2012).
According to Barth, Burkhart, and De Beer (2006), a positive Lift-Off Test is not found
unless 75% of the subscapularis is torn.
van Kampen et al. (2014) reported that the Lift-Off Test has a specificity and positive
predictive value of 100%
13
Sulcus Sign
Assessment: Inferior shoulder instability or laxity
Pt position: Relaxed seated or standing
Test position: Arm at the patients side with shoulder relaxed
Administration: The examiner grasps the distal portion of the humerus and provides an inferior
traction force.
Positive finding: The presence of a sulcus sign beneath the acromion process is indicative of
inferior instability.
(Magee, 1997)
14
Literature:
Sensitivity: 72%, specificity: 96%, and likelihood ratio: 20.2% (Farber et al., 2006)
According to Powell, Huijbregts, and Jensen (2008), a positive finding on the Anterior
Apprehension Test provides the examiner with research-based confidence to rule in a
SLAP lesion.
According to Lo et al. (2004), the anterior apprehension test is highly specific and likely to
predict traumatic anterior glenohumeral instability.
The anterior apprehension test is highly reliable when it was positive, with a positive
predictive value of 96%. Therefore, a MRI may be unnecessary in evaluating a young
patient with clinically evident anterior shoulder instability if the apprehension test is
positive (Kumar et al., 2015)
15
SLAPprenension Test
Assessment: SLAP lesion, anterior instability
Pt position: Relaxed seated position
Test position: Position the patient in 90 of shoulder abduction with the elbow extended, shoulder
internally rotated, and forearm pronated.
Administration: Examiner slowly horizontally adduct the arm. The test is repeated with the
shoulder externally rotated and forearm supinated.
Positive finding: Any pain in the bicipital groove with or without an audible or palpable pop of
the biceps tendon in pronated position should decrease or be eliminated in the supinated test
position. No decrease in pain is indicative of a negative finding.
Test 1:
Test 2:
Literature:
Berg and Ciullo (1998) reported that a retrospective chart review of 66 consecutive
arthroscopically verified shoulders with SLAP lesions revealed the SLAPprehension test to
be 87.5% sensitive for unstable SLAP lesions. Therefore, the SLAPprehension test is
helpful in the clinical evaluation of patients with unstable superior glenoid labrum lesions
whose symptoms are often confused and overlap with those of shoulder impingement or
acromioclavicular arthrosis.
16
17
Speeds Test
Assessment: Biceps Tendonitis
Pt position: Relaxed seated of standing
Test position: Palpate the bicipital groove (biceps tendon origin). Position the patient in 90
shoulder flexion, slight external rotation, full elbow extension, and forearm supination
Administration: Apply downward resistance distal to the radial tuberosity, and ask the patient to
resist the eccentric movement to shoulder extension.
Positive finding: Localized pain or increased tenderness in the bicipital groove
Literature:
Kibler et al. (2009) reported that the combination of the Upper Cut and Speeds tests were
significantly better at detecting biceps lesions than other tests.
According to Magee (1997), the Speeds test is more effective than Yergasons test because
the bone moves over the tendon during the test.
According to Guidi and Suckerman (1994), the Speeds test may cause pain and is positive
if a SLAP lesion is present.
According to Powell, Huijbregts, and Jensen (2008), a positive finding on the Speeds Test
provides the examiner with research-based confidence to rule in a SLAP lesion.
Sensitivity: 32% and specificity: 61% for SLAP tears (Hegedus et al., 2008)
According to Hegedus et al. (2008), the Speeds test has no diagnostic utility for a SLAP
lesion, contradicting the article published by Powell, Huijbregts, and Jensen (2008).
(Magee, 1997)
18
Yergasons Test
Assessment: Biceps Tendonitis
Pt position: Relaxed standing or sitting
Test position: Position the patients elbow in 90 flexion and stabilized against the thorax with
forearm pronated (may ask patient to hold towel between medial epicondyle and thorax to ensure
stabilization and reduce compensation).
Administration: The examiner instructs the patient to supinate and externally rotate
simultaneously against resistance. While resisting, palpate the bicipital groove to feel for a pop in
the biceps tendon.
Positive finding: Tenderness in the bicipital groove. The tendon may also pop out of the groove
upon administration, which is indicative of a positive finding.
Literature:
According to Guidi and Suckerman (1994), Yergasons Test is not as effective as Speeds
Test because the tendon only moves a small amount in the bicipital groove during the test
and biceps tendon pain tends to occur with motion or palpation rather than with tension.
According to Powell, Huijbregts, and Jensen (2008), a positive finding on the Yergason
Test provides the examiner with research-based confidence to rule in a SLAP lesion.
(Magee, 1997)
19
20
(Magee, 1997)
21
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