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Shoulder Examination Tests

Numerous clinical tests described for shoulder examination.
Many similar tests have been described by different people and given different names. Also, many different tests have been described by the same person. This can cause confusion.

So far, I have tried to collect as many of the tests I can find and list them here. So far I have found 113 .

I hope to add descriptions, videos and references for the tests soon. If you have a description, reference or even a test not listed here, please email info@shoulderdoc.co.uk .
Also, some of the descriptions or names below might be incorrect. Please email us if you find inaccuracies below.

SHOULDER CLINICAL TESTS 
113(so far)

• General Shoulder Pathology
  - Mazion Shoulder Maneuver - -Pt. Seated, Pt. Places hand on opposite shoulder, moves elbow to forehead - (+)intensifies & localized pain
  - Codman Sign - tests passive motion of shoulder. Examiner stands behind patient and stabilises scapula with one hand, whilst other hand holds patient's arm and moves arm in every direction. In early stages of cuff disease only active motion is reduced, but later passive motion reduces.
  - Palm Sign and Finger Sign Test - Patient demonstrates their pain in two ways: with palm of opposite hand over acromion (= subacromial or GHJ pain), or with opposite finger over ACJ (= ACJ pathology) 
   
• Shoulder Dislocation
  - Dugas - Pt. Seated & instructed to place hand on opposite shoulder and touch elbow to chest - (+)pain & inablility to perform indicates dislocation
  - Calloways - -measure girth of affected shoulder & compare to unaffected -(+)increased girth indicates dislocation
  - Bryants Sign - look for lowering of axillary fold - (+)dislocation on low side
   
• anterior Instability
  - anterior Load and Shift (laxity test) -
  - anterior Drawer Test   ( Gerber-Ganz anterior Drawer Test) - Pt. is supine and arm abducted over edge of couch. Examiner immobilisers scapula with one arm whilst the other grasps the arm and pulls it anteriorly.
  - anterior Apprehension
  - Jobe Relocation  (Fulcrum Test) - Original Article
  - Rowe Test - Pt. bends forward slightly with the arm relaxed.The examiner move the arm slightly inferior and anterior by pulling on the forearm
  - Throwing Test - Pt. executes a throwing motion against the examiners resistance. anterior subluxation may occur.
  - Leffert Test - Examiner displaces the humeral head anteriorly holding the humeral head over the shoulder with the thumb posteriorly and index finger anteriorly. Displacement of the index finger is positive
  - Surprise/Release Test - This manoeuvre is variously described but essentially is the fmal component of the apprehension and relocation tests. It is an extremely provocative test and should be used with caution. As in the Jobe relocation tests the patient's arm is maximally externally rotated with a posteriorly directed force applied to the humeral head. At the limit of range the examiner suddenly removes the posteriorly directed force from the relocation test and again a feeling of apprehension is considered a positive test. (courtesy of Jo Gibson, specialist shoulder therapist, Liverpool)
  - Dynamic anterior Jerk Test - The test combines of a compression force and a translation force, applied along the arm between the humeral head and the glenoid cavity. In so doing, a subluxation of the humeral head is provoked and it is accompanied with a jerk recognised by the patient as his instability.
  - Dynamic Relocation Test
  - Dynamic Rotatory Stability Test
  - Bony Apprehension Test - identical to the standard apprehension test except that the arm is brought to only 45ø of abduction and 45ø of external rotation. A positive result should alert the examiner to the possibility of a bony lesion as the cause of symptomatic shoulder instability. 
  - Kinetic medial Rotation Test - used to differentiate to help determine whether symptoms are primarily impingement or instability. The subject lies supine with 90deg humeral abduction (hand to the ceiling with the humerus in the plane of the scapula). The assessor places one finger on the coracoid process and one on the humeral head. The subject is asked to actively medially rotate the humerus. The ideal is 70deg rotation without any finger movement. If the coracoid finger moves before 70deg then there is an increase in scapula relative flexibility and impingement risk. If the humeral finger moves before 70deg then there is displacing axis of rotation of the humeral head and an instability risk. If both fingers move forward then there is a combined impingement and instability risk. This test obviously needs to be used with other instability and impingement tests to confirm diagnosis but it is a good rehab indicator for where the primary focus should be.   (many thanks to Andy Barr)
   
• posterior Instability
  - posterior Load and Shift - posterior Drawer Test
  - Gerber-Ganz posterior Drawer Test- same as anterior drawer except with posterior force.
  - posterior Apprehension test - arm adducted and flexed. Examiner pushes posteriorly - apprehension positive.
  - Jerk Test
  - Fukuda Test - Elicits a passive posterior drawer sign. The examiner stands with thumb resting on scapula spine and fingers over front of humeral head exerting a posterior force.
   
• inferior Laxity
  - Gagey's Hyperabduction Test
  - Sulcus Sign at 0 Degrees
  - Sulcus Sign at 90 degrees
  - inferior Apprehension Test - The examiner supports the 90 degree abducted arm with one hand. With the other hand the examiner tries to invoke an inferior subluxation by applying pressure downward on the patients upper arm.
   
• Multidirectional Instability
  - Kibler's Corkscrew test - for core instability
   
• SLAP Lesions
  - O'Brien's Test
  - anterior Slide Test (Kibler)   - Pt sitting with hands on hips and thumbs pointing posteriorly. Examiner places on hand on top of affected shoulder and other hand on point of elbow. Examiner then applies a forward and superior force on the elbow. Pt asked to resist this force. Pain over the front of the shoulder or a click is positive. (Kibler, Arthroscopy, 1995)
  - posterior Slide Test
  - Luddington's Test - hands on top of head & push down
  - Curtain's Test (Martin Holt) - opening curtain with arm in 90 deg abduction
  - Kibler's grind test
  - LaFosse AERS Test - Ab duction Supination External Rotation
  - SLAPprehension Test  - Original Article
  - Feagin Test
  - Biceps Load Test 1  
  - Biceps Load Test 2 - Original Article
  - Compression Rotation Test (Crank Test)   - performed with the patient lying and elevating the shoulder with the elbow flexed at 90 degrees. An axial load is applied while the arm is rotated internally and externally and circumducted. A click associated with pain makes the test positive. This mechanism is similar to the McMurray test for a torn meniscus in the knee.
  - O'Driscoll's SLAP Test - Shoulder is placed in the extreme abducted and externally rotated position. From this position a valgus stress is applied and a positive response is signified by pain at the shoulder.  (from Krishnan, Hawkins & Adams. The Shoulder and the Overhead Athlete)
  - Pain Provocation Test - Examiner places one hand over scapula, whilst other hand hold patient's wrist. The patient's arm is in 90deg. abd & 90deg. ER, with elbow flexed 90deg. Pt. then asked to supinate & pronate the forearm. Pain worse on pronation indicates a SLAP tear. (Mimori et al. Am J Sports Med, 1999)
  - The Resisted Supination External Rotation Test - Original Article
  - The Passive Compression Test - Original Article
  - The Supine Flexion Resistance Test - Original Article
   
• Bankhart Lesions
  - Clunk 1 Test
  - Clunk 2 Test
  - Dynamic Shear (Mayo) Test
   
• Rotator Interval Laxity
  - Sulcus with shoulder in external rotation (?test name)
  
  
• Long Head of the Biceps
  - Yergasons Test
  - Speed's Test - resisted flexion with straight arm forward 90 degrees and externally rotated.
  - Ludington's Test - Pt. Seated & places both hands behind head with interlocked fingers, pt. Contracts & relaxes biceps while Dr. feels for tendons-(+)rupture of long heads if Dr. is unable to feel tendon
  - Abbot-Saunders - Pt. Seated, passive abduction, external rotation and lowering of arm, Dr. Palpates long head tendon-(+)a palpable click indicates dislocation of biceps tendon
  - Transverse Humeral ligament Test - Pt. Seated, passive abduction of arm with elbow extended, shoulder is then internally rotated & externally rotated, Dr. palpates bicipital groove.-(+)If Dr. feels tendon snap in & out of groove, indicates torn transverse humeral ligament
  - Snap Test - test for subluxation of LHB. The examiner palpates the biceps groove with one hand whilst the other hand rotates the shoulder.
  - Hueter Sign - Pt. seated with elbow extended and forearm supinated. The asked to flex elbow against resistance. Formation of a biceps 'ball' shows a LHB rupture.
  - Duga Sign - where a LHB lesion is present the patient will not be able to touch the contralateral shoulder
  - Beru Sign - displacement of LHB can be palpated below the ant. deltoid when biceps is contracted.
  - Traction Test - passive extension of the shoulder with the elbow extended and forearm pronated causes pain in the anterior deltoid region along LHB
  - Compression Test - Passive elevation of the arm to the end of ROM with continued application of posterior pressure produces pain as a result of compression of LHB betw. acromion and humeral head.
   
• AC Joint
  - anterior/posterior AC Shear Test -Pt. sitting, examiner cups both hands with one over scapula and one over clavicle and then squeezes. (Davies et al. Phys Sports Med 1981)
  - Cross chest Adduction (Scarf / Forced Adduction Test) - the 90 degrees flexed arm on the affected side is forcibly adducted across the chest. - video   [from Silliman JF, Hawkins RJ: Clinical Examination of the Shoulder Complex. In Andrews JR, Willk KE (eds): The Athlete's Shoulder. New York, Churchill Livingstone. 1994.]
  - Forced Adduction Test on Hanging Arm - the examiner grasps the affected arm with one hand whilst the other hand rests on the patients opposite shoulder. The examiner forcible adducts the hanging affected arm behind the patient's back against the patient's resistance.
  - Dugas Test - the seated patient touches the opposite shoulder with the hand
  - AC Distraction (Bad cop) Test - place the arm in maximal internal rotation and apply slight pressure upward. A positive test is pain at the top of the shoulder.
  - Paxinos Test - The examiner's hand is placed superior to the ipsilateral mid-clavicle. Pressure is applied by the thumb in an anterosuperior direction and inferiorly with the index-middle finger to the midshaft of the clavicle. (from Krishnan, Hawkins & Adams. The Shoulder and the Overhead Athlete)
   
• Subacromial Impingement
  - see Impingement Presentation
  - video of Impingement examination tests
  -  Neer Sign - pain with passive abd. in scapula plane, shoulder internally rotated - video
  - Neer Test - injection test.
  - Hawkin's-Kennedy Test - video
  - Empty can/ full can test - video
  - Copeland Impingement Test - passive abduction pain eliminated with shoulder in external rotation - video
  - Horizontal Impingement test - Hawkins in 90deg abduction & no flexion
  - Dawburn's Test  - Pt. Seated, Dr. palpates painful subacromial bursa, & passively abducts arm-(+). If pain disappears with increasing abduction this indicates bursitis
  - Coracoid Impingement Test - pain directly over coracoid with arm passively adducted across chest (distingiush from ACJ scarf test)
  - Internal Rotation Resistance Strength Test (IRRST)  - The subject is asked to maximally resist first external rotation and then internal rotation with the arm in 90ø abduction and 80ø ER. (provided courtesy of Mohamed AbdAlla, Egypt)
  - Bursitis Sign - Examiner palpates anterolateral subacromial region. Pain = positive for bursitis.
  - Impingement Relief Test - the patient abducts arm through full motion five times and indicates painful arc. The examiner then applies an inferior and posterior force on the humeral head during the painful phase, which relieves the impingement pain.
  
   
• Rotator Cuff Tear
  - video of rotator cuff tests
  1. Supraspinatus:
  - Apley's Scratch Test - Reach over shoulder to "scratch" between scapula. Measure to which vertebrae thumb can reach
  - Jobes Supraspinatus test (also called 'Empy can test')
  - Dawburn's sign - The pain is worse when lowering the arm from overhead
  - Sherry Party sign (Roger Emery)
  - Codman's Sign (Drop Arm Sign)  - A sign seen in the absence of rotator cuff function or when there is a rupture of the supraspinatus tendon: the arm can be passively abducted without pain, but when support of the arm is removed and the deltoid contracts suddenly, the pain produced causes the patient to hunch the shoulder and lower the arm.(E. A. Codman:The Shoulder: Rupture of the Supraspinatus tendon and Other Lesions in or about the Subacromial Bursa. Boston : Privately printed, 1934. Reprint, Malabar, Florida : Krieger, 1965.)
  - Rent Test - Described by Codman. Palpation of a supraspinatus tear through the deltoid. This is accomplished in a relaxed patient at the anterolateral border of the acromion.  Sensitivity = 95.7%, specificity = 96.8% (from Wolf et al. JSES 2001 )
  - Zero Degree Abduction Test - Patient standing with arms by their side. Reisted abduction causing pain or weakness suggests a rotator cuff tear.
  - Ludington Sign - The seated patient asked to place both hands behind the neck. If the patient has to make compensatory motions or is able to place one hand behind the neck only with assistance this may indicate a rotator cuff tear.
  - Scapular Retraction Test - setting the scapular in a retracted position improves the supraspinatus strength, optimising a weakened cuff and giving a truer idea of supraspinatus power.
  - Burkhead's Thumbs down & Burkhead's Thumbs up (Many thanks to Nicholas Ansell) -  These are two alternative tests that can be used to test the integrity of the rotator cuff out of the painful arc. If there is pain on the Hawkin's test, Jobe's test can be difficult to differentiate if the weakness observed is due to true supraspinatus weakness or an inability to maintain the position because of pain.  
  Burkhead's thumbs up: the examiner places the patient's arm to approximately 60-80 degrees of forward elevation in the scapula plane out of the painful arc. The patient attempts to raise the arm upwards while the examiner resists this movement. If there is pain this can be a sign of impingement due to antero-superior cuff weakness.  
  Burkhead's thumbs down: the examiner places the patient's arm to approximately 60-80 degrees of forward elevation in the scapula plane out of the painful arc and then pronates the forearm so that the thumb is facing downwards. The patient attempts to raise the arm upwards while the examiner resists this movement. If there is pain this can be a sign of postero-superior cuff weakness.
  
  2. Infraspinatus:
  - External Rotation Lag Sign
  
  3 Subscapularis:
  - Internal Rotation Lag Sign Test
  - Gerber's Lift off test (Gerber 1991 ,  Gerber 1996 ,  Greis 1996 )
  - Belly Off Sign - the examiner tries to pull the hand away from the abdomen.
  - Belly Press / Napoleon Sign - if patient cannot fully internally rotate and push on their belly, elbow will drop backwards if positive. The examiner pushes against the patient's elbows. (Laurent La Fosse)
  - Bear-Hug Test - for subscap - arm across chest holding opp. lat dorsi and try pull arm away (Burkhart & De Beer)
  
  4. Massive cuff tear:
  - Hornblower's sign - an inability to externally rotate the elevated arm; demonstrates severe infraspinatus and teres minor weakness.
  - The Dropping Sign (Walch) - With a seated patient the shoulder is placed in 0ø of abduction, and 45ø of external rotation with the elbow flexed to 90ø. The examiner holds the patient's forearm in this position, instructs the patient to "maintain this position when he lets go of the forearm." On releasing the forearm a positive test is recorded when the patient's forearm drops back to 0ø of external rotation, despite the patient's efforts to maintain external rotation.
  - French Horn Shoulder Test (Internal & External rotation)
  - 90/90 Drop Lag Test
  
  Also see: Comparison of the Hornblowers and Dropping Sign
   
• Internal Impingement Syndrome
  - posterior Impingement Sign - Pt. supine with shoulder in 90 deg. abd and elbow in 90deg flexion. Examiner stabilises elbow and applies ER force to maximum ER.
  - Compression test
  - GIRD - Glenohumeral Internal Rotation Deficit (Burkhart) - post capsular tightness
   
• posterior Labral Tear
  - Push-Pull Test - The patient is supine and the arm held at the wrist with the shoulder at 90 degrees abduction and neutral rotation. The examiner places the other hand on the proximal humerus and while pulling with the arm holding the patient's wrist, the examiner pushes with the arm on the proximal humerus. This is often enough to maximally translate the patient's humeral head posteriorly. The test is positive if it reproduces the patients symptoms. (from Krishnan, Hawkins & Adams. The Shoulder and the Overhead Athlete)
  - Jahnke Jerk Test - Performed seated or supine. The affected arm is placed in maximal horizontal adduction and internal rotation and a posterior force applied. This causes posterior subluxation. Next the shoulder is brought back from horizontal adduction while maintaining posterior force on the humerus at the elow. As the shoulder approaches normal a cluck may herald reduction of the subluxed shoulder, which is a positive test. (from Krishnan, Hawkins & Adams. The Shoulder and the Overhead Athlete)
  
  -  Painful Jerk Sign Test
  - Kim Test   (provided courtesy of Mohamed AbdAlla, Egypt)
   
• Frozen Shoulder
  - Shoulder Quadrant Test
   
• Subcoracoid Impingement
  -  Coracoid Impingement Sign - performed with the patient standing with the shoulder abducted 90 degrees with horizontal adduction in the coronal plane and maximally internally rotated (the tennis "follow through" position).  (from Krishnan, Hawkins & Adams. The Shoulder and the Overhead Athlete)
   
• Others
  - Military Brace Test (Roos Test)
  - Brachial Plexus Stretch Test
  - SC Joint stress test
  - Scapula Pinch / Retraction Test (for scapula stability) - Pt sitting and maximally retracting scapula. Hold for 15 seconds(Kibler Am J Sports Med 1998).
  - Thompson and Kopell Horizontal Flexion Test - Standing Pt. moves the 90 degree abducted arm across the body into maximum horizontal flexion. Pain over the back of the scapula indicates possible suprascapular nerve entrapment (same as Scarf test).
   

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