Top 10 Shoulder joint special tests -

March 3, 2022 Dr Lalit Choudhary 0 Comments

EMPTY CAN TEST
Purpose: Test supraspinatus muscle
Position: Seated
Technique: shoulder abduction 90 degrees , forward flexion 30 degrees internally rotated , thumb is pointing toward the floor. Second Technique: Elevate UE 30°–45° in plane of the scapula with IR, resist elevation Interpretation: + test = reproduction of pain &/or drop arm due to weakness
Statistics: Pain: sensitivity = • Pain 55%, muscle weakness 68%, pain, muscle weakness or both 50% & specificity = Pain 63%, muscle weakness 77%, pain, muscle weakness or both 89% Weakness: sensitivity = 77% & specificity = 68%

FULL CAN TEST
Purpose: Test supraspinatus muscle
Position: Seated
Technique: Elevate UE 30°–45° in plane of the scapula with ER, resist elevation
Interpretation: + test = reproduction of pain &/or weakness
Statistics: Pain: sensitivity = 66% & specificity= 64%
Weakness: sensitivity = 77% & specificity = 74%

DROPPING SIGN
Purpose: Test infraspinatus muscle
Position: Seated
Technique: Shoulder at side with 45° of IR & 90° elbow flexion, resist ER
Interpretation: + test = reproduction of pain &/or weakness
Statistics: Sensitivity = 36%–100% & specificity = 100% at 90° abduction and 45° external
rotation for infraspinatus tear

Dropping sign. (A) Start position with the examiner resisting the patient’s lateral rotation at 45° of lateral rotation.
(B) Arm dropping back to neutral position (arrow) because of infraspinatus weakness

HORNBLOWER’S (PATTE TEST)
Purpose: Test teres minor muscle
Position: Seated
Technique: Shoulder in 90° abd & elbow flexed so that the hand comes to the mouth (blowing a horn)
Interpretation: + test = reproduction of pain &/or inability to maintain UE in ER

Hornblower’s sign (signe du clairon). (A) The patient is in a standing position. The examiner elevates the patient’s arm to 90° in the scapular plane (scaption). The examiner then flexes the elbow to 90° and the patient is asked to laterally rotate the shoulder against resistance.
**(B) McClusky modification: patient is asked to abduct the arms to bring the hands to the mouth. A positive test is shown**

RENT SIGN
Purpose: Diagnosis RC tears
Position: Seated with UE in full ext & clinician’s hand under the flexed elbow
Technique: Stand behind pt with fingertips in the anterior margin of the acromion; IR/ER
UE & palpate for an eminence & a rent; compare bilaterally
Interpretation: + test = presence of a palpable defect in RC
Statistics: Sensitivity = 95% & specificity = 96%

GERBER’S LIFT-OFF SIGN
Purpose: Test subscapularis muscle
Position: Seated
Technique: Hand in the curve of lumbar spine, resist IR
Interpretation: + test = reproduction of pain &/or weakness; inability to lift off
Statistics: Sensitivity = 62%–89% & specificity = 98%–100%; tears 75% are often required to produce a + test

Lift-off sign. (A) Start position. (B) Lift-off position. (C) Resistance to lift off is provided by the examiner. The examiner tests the strength of the subscapularis and watches the positioning of scapula

BELLY PRESS OR NAPOLEON SIGN

Purpose: Test subscapularis muscle Position: Seated with hand on belly Technique: Press the hand into belly Interpretation: + test = reproduction of pain &/or inability to IR; substitution may result in UE elevation or wrist flexion Statistics: Sensitivity = 25%–40% & specificity = 98%; tears >50% are often required to produce a + test

BEAR-HUG TEST

Purpose: Test subscapularis muscle Position: Seated with palm of hand on opposite shoulder (elbow in front of body) Technique: Resist IR by attempting to pull hand off the shoulder Interpretation: + test = inability to hold the hand against the shoulder or weakness >20% of contralateral UE Statistics: Sensitivity = 60% & specificity= 92%; tears of 30% can be detected with this test

HAWKINS/KENNEDY TEST

Purpose: Test for impingement

Position: Seated

Technique: Place shoulder in 90° of flexion, slight horizontal adduction, & maximal IR

Interpretation: + test = shoulder pain due to impingement of supraspinatus between greater tuberosity against coracoacromial arch

Statistics: Sensitivity = 72%–92% & specificity = 25%–66%

The coracoid impingement sign with the arm flexed to
90°, adducted to 10°, and rotated internally. The test is positive if it
produces pain in the area of the coracoid.

Modified Hawkins-Kennedy impingement test. Note the position of the examiner’s right arm.

NEER’S TEST

Purpose: Test for impingement

Position: Seated

Technique: Passively take UE into full shoulder flexion with humerus in IR

Interpretation: + test = pain may be indicative of impingement of the supraspinatus or long head of the biceps

Statistics: Sensitivity = 68%–95% & specificity = 25%–68%

(A) A positive Neer impingement sign is present if pain and its resulting facial expression are produced when the examiner forcibly flexes the arm forward, jamming the greater tuberosity against the anteroinferior surface of the acromion.
(B) An alternative method (Hawkins-Kennedy impingement test) demonstrates the impingement sign by forcibly medially rotating the proximal humerus when the arm is flexed forward to 90°

Modified Neer test

Neer test with the patient seated and the examiner stabilizes the clavicle and scapula with one hand while abducting the test arm, in which the elbow is flexed to 90° and the palm faces the floor, as far as possible. The examiner then laterally rotates the abducted arm.

A disappearance of pain with the second part of the test is considered a positive sign for impingement. If the pain did not disappear in the second part of the test or if the patient is unable to abduct the arm, the test is negative for impingement.