The Shoulder Exam Basics

 

Rotator Cuff

Drop Arm

  • Technique

    • Patient seated or standing

    • Examiner in front or behind patient

    • Patient actively abducts arms overhead and then slowly lowers them.  Examiner can gently tap at the patient’s elbows as the arms lower.

    • A positive result occurs when the affected arm drops down suddenly due to weakness or pain. 

    • A negative result occurs when there is no sudden drop and no pain.

Suprasinatus Challenge/Empty Can

  • Technique

    • Patient seated or standing

    • Examiner in front of or behind patient

    • Patient’s arms abducted and slightly horizontally adducted (plane of scapula or scaption).  Examiner applies downward pressure at the patient’s elbows.

    • A positive result occurs when the affected extremity is weak and/or painful, compared to the unaffected side.

    • A negative result occurs when there is no pain or weakness symmetrically.

Lift-off 

  • Specifically tests the subscapularis

  • Technique

    • Patient seated or standing and places the dorm of the affected arm on the small of their back

    • Examiner behind or to the side of patient and places a hand on the patient’s palm behind their back, and has the patient press into the examiner’s hand.

    • A positive finding occurs when the patient is unable to lift their hand off of their back, indicating weakness, and/or significant pain is elicited.

    • A negative result occurs when there is no strength deficit or pain with the maneuver.

Belly-press Test

  • Specifically tests the subscapularis

  • Technique

    • Patient seated or standing and presses the palm of the affected extremity hand into their belly while the examiner resists by either placing a hand in between the patient’s hand and belly or grasping the wrist.  With other hand, the examiner stabilizes the patient’s elbow.

    • A positive result occurs when there is weakness and/or pain with the maneuver.

    • A negative result occurs when no symptoms are elicited.

 

Impingement 

Neer

  • Technique

    • Patient seated or standing

    • Examiner in front or slightly to the side of the patient, with a hand or hands placed at the the patient’s elbow or wrist.  

    • The patient’s arm is then passively forward flexed  and internally rotated, bringing the arm to the patient’s ear.  (Memory cue:  elbow Neer to ear)

    • A positive result occurs when the maneuver recreates the patient’s pain

    • A negative result occurs when the maneuver does not elicit pain

Hawkins, Hawkins-Kennedy

  • Technique

    • Patient seated or standing

    • Examiner in front or slightly to the side of the patient’s arm being tested with one hand placed on the patient’s elbow and the other grasping the patient’s wrist.

    • The patient’s shoulder is passively forward flexed to 90°, elbow is flexed to 90°, and then internally rotated.

    • A positive result occurs when pain is elicited.

    • A negative result occurs when no pain is recreated.  

 

Biceps Tendon

Speed’s

  • Technique

    • Patient is seated or standing with both arms actively held at 90° of forward flexion with hands supinated, palms facing ceiling 

    • Examiner stands in front of patient and presses downward at the patient’s elbows.

    • A positive finding occurs when the maneuver elicits symptoms

    • A negative finding occurs when no symptoms are recreated

Yergason’s

  • Technique

    • Patient seated or standing with the shoulder by side, elbow flexed to 90°, and forearm pronated

    • Examiner slightly to the patient’s side with the outer hand grasping patient’s shoulder with thumb over bicipital groove.  Inner hand grasping patient’s wrist.  Have the patient actively flex the elbow and supinate the forearm, while examiner resists.

    • A positive result occurs when the maneuver elicits pain and/or biceps tendon subluxation is palpated.

    • A negative result occurs when no symptoms a recreated

 

Labrum

O’Brien’s

  • Technique

    • Patient seated or standing with affected shoulder forward flexed, horizontally adducted just across midline, and internally rotated, thumb to the floor

    • Examiner in front of patient with a hand pressing the patient’s arm downward at the elbow

    • A positive result occurs when the maneuver recreates pain

    • A negative result occurs when the maneuver does not recreated pain

 

AC Joint

Scarf/Cross-arm

  • Technique

    • Patient seated or standing and actively fully horizontally adducts the affected shoulder at shoulder hight across the body, as if putting on a scarf.

    • Examiner in front of, behind, or to the side of the patient.  If active maneuver is negative, passively forward flex the shoulder, while it is fully horizontally adducted.

    • A positive result occurs when superior shoulder/AC joint pain is elicited.

    • A negative result occurs when the maneuver does not elicit pain.

Stability

 

Sulcus Sign

  • Technique

    • Patient seated or standing with the arm relaxed by the side

    • Examiner slightly to the patient’s side, either front or back with a hand or hands grasping the patient’s arm at the elbow or wrist, and distracts downward.

    • A positive result occurs when an indention is created just below the acromion, laterally, especially if it is more significant than the opposite side.

    • A negative result is when there is no significant indention.

    • More of an indication of general laxity

Apprehension/Relocation Sign

  • Technique

    • Patient supine on table with affected shoulder and elbow at 90° on the edge of the table

    • Examiner places knee under the patient’s elbow, and places one hand on patient’s wrist and the other palm down on patient’s humeral head. Gently externally rotate. 

      • A positive finding occurs when the patient demonstrates visible or audible apprehension.  Stop the ER and hold the position.

      • If a positive occurs,  gently press palm into the humeral head, while holding the position of apprehension.

      • A positive relocation sign occurs when pressing the humeral head relieves symptoms

      • A negative finding occurs when there is no apprehension throughout full external rotation