Shoulder - Special Tests

Tests for Anterior
Shoulder Instability

1. Load and Shift Tests
Pt. sits w/ no back support & w/ the hand of
the test arm resting on the thigh. The
examiner stabilized the shoulder w/ one hand
over the clavicle & scapula. The other hand
grasps the head of the humerus w/ the thumb
over the post. Humeral head & the fingers
over the ant. Humeral head. The humerus is
then gently pushed anteriorly or posteriorly

2. Apprehension ( Crank Test )
for ant. Dislocation
The examiner abducts the arm to 90˚ &
laterally rotates the pt’s shoulder slowly . By
placing a hand under the GH jt. to act as a
fulcrum. Applying a mild anteriorly directed
force to the post. Humeral head when in the
test position to see if apprehension or pain
↑.
If post. Pain ↑, indicates POST. INTERNAL
IMPINGEMENT.

- If post. Superior internal
impingement is suspected, relocation
test should be done in 110˚ & 120˚ of
abduction.
+ test : is indicated when the pt. looks or feels
apprehensive or alarmed and resists further
motion.
Fowler Sign or Jobe Relocation Test

3. Rockwood Test
for ant. Instability
The examiner laterally rotates the shoulder.
The arm is abducted to 45˚, and passive
lateral rotation is repeated. Same
procedure is repeated at 90˚ & 120˚
+ test: show marked apprehension w/ post.
Pain when the arm is tested at 90˚. At 45˚
& 120˚, the pt. shows some uneasiness &
some pain; at 0˚, there is rarely
apprehension.

4. Rowe Test
For ant. Instability
Pt. lies supine & places the hand behind
the head. The examiner places one
hand (clenched fist) against the post.
Humeral head & pushes up while
extending the arm slightly.
+ test: apprehension or pain.
If a clunk or grinding sound may indicate
a torn ANTERIOR LABRUM.

5. Prone Anterior Instability Test
Prone. The examiner abducts the pt’s
arm to 90˚ and laterally rotates it 90˚.
While holding this position w/ one hand
at the elbow, the examiner places the
other hand over the humeral head and
pushes it forward.
+ test: reproduction of pt’s symptoms

6. Andrew’s Ant. Instability Test
Supine w/ sh. Abducted 130˚ and
laterally rotated 90˚. The examiner
stabilizes the elbow and distal humerus
w/ one hand & uses the other hand to
grasp the humeral head & lift it forward.
+ test: reproduction of pt’s symptoms

7. Ant. Drawer Test of the Shoulder
Supine. The examiner places the hand of the
affected shoulder in the examiner’s axilla, holding
the pt’s hand w/ the arm so that the pt. remains
relaxed. The sh. To be tested is abducted bet. 80˚
& 120˚, forward flexed up to 20˚, and laterally
rotated up to 30˚. The examiner then stabilizes
the pt’s scapula w/ the opposite hand, pushing
the spine of the scapula forward w/ the index and
middle fingers. The examiner’s thumb exerts
counterpressure on the pt’s coracoid process.
Using the arm that is holdingthe pt’s hand, the
examiner places his or her hand around the pt’s
relaxed upper arm & draws the humerus forward.
+ test: indicates ant. Instabilty depending on the
amount of ant. Translation.

8. Protzman Test
For ant. Instability
Sitting. The examiner abducts the pt’s arm to
90˚ & supports the arm against the examiner’s
hip so that the pt’s sh. Muscles relaxed. The
examiner palpates the ant. Aspect of the head
of the humerus w/ the fingers of one hand deep
in the pt’s axilla while the fingers of the other
hand are placed over the post. Aspect of the
humeral head. The examiner then pushes the
humeral head anteriorly & posteriorly.
+ test: if this mov’t causes pain & if palpation
indicates abnormal anteroinferior mov’t.

9. Anterior Instability Test ( Lefferts Test
)
Sitting. The examiner places his/ her near hand
over the sh. So that the index finger is over the
head of the humerus anteriorly & the middle
finger is over the coracoid process. The thumb
is placed over the post. Humeral head. The
examiner’s other hand grasps the pt’s wrist &
carefully abducts & laterally rotates the arm.
+ test: if, on mov’t of the arm, the finger
palpating the ant. Humeral head moves forward.

10. Dugas’ Test
Used if an unreduced ant. Sh.
Dislocation is suspected.
The pt. is asked to place the hand on
the opposite sh. & then attempt to lower
the elbow to the chest.
With an ant. Dislocation, this is not
possible, and pain in the shoulder
results.

Tests for Posterior

1. Load and Shift Test
Described under anterior shoulder
instability.

2. Posterior Apprehension or Stress
Test
Supine or sitting. The examiners
elevates the pt’s shoulder in the plane of
the scapula to 90˚ while stabilizing the
scapula w/ the other hand then applies a
post. Force on the pt’s elbow. While
applying axial load, the examiner
horizontally adducts and medially
rotates the arm.
+ test: apprehension

3. Norwood Stress Test
Supine w/ sh. Abducted 60˚ to 100˚ and
laterally rotated 90˚ & w/ the elbow flexed
to 90˚ so that the arm is horizontal. The
examiner stabilizes the upper limb by
holding the FA and elbow at the elbow or
wrist. The examiners then brings the arm
into horizontal adduction to the forward
flexed position. The examiners feels the
humeral head slide posteriorly w/ the
fingers.
+ test: if the humeral head slips posteriorly
relative to the glenoid

4. Push-Pull Test
Supine. The examiner holds the pt’s arm at
the wrist, abduct’s the arm 90˚, & forward
flexes it 30˚. The examiner places the other
hand over the humerus close to the humeral
head. The examiner then pulls up on the
arm at the wrist while pushing down on the
humerus w/ the other hand.
+ test: if more than 50% posterior translation
occurs or if the pt. becomes apprehensive or
pain results.

5. Posterior Drawer Test of the
ShoulderSupine. The examiner grasps the pt’s proximal FA w/
one hand, flexing the pt’s elbow to 120˚ and the
shoulder bet. 20 ˚& 120˚ of abduction & bet. 20˚ & 30˚
of forward flexion. With the other hand, the examiner
stabilizes the scapula by placing the index & middle
fingers on the spine of the scapula and the thumb on
the coracoid process. The examiner then rotates the
upper arm medially & forward flexes the sh. To bet. 60˚
& 80˚ while taking the thumb of the other hand off the
coracoid process & pushing the head of the humerus
posteriorly. The head of the humerus can be felt by the
index finger of the same hand.
+ test: pain free, but the pt. may exhibit apprehension.

6. Miniaci Test for Posterior Subluxation
Supine w/ the sh. Off the edge of the
examining table. The examiner uses one
hand to flex ( 70 to 90 ), adduct, & medially
rotate the arm while pushing the humerus
posteriorly. With the other hand, the examiner
palpates the ant. & post. Shoulder. The
examiner then abducts & laterally rotates the
arm.
+ test: a clunk will be heard, & the humerus
reduces (relocates).

7. Jerk Test
Sitting w/ the arm medially rotated & rotated
forward flexed to 90˚. The examiner grasps
the pt’s elbow & axially loads the humerus in
a proximal direction. While maintaining the
axial loading, the examiner moves the arm
horizontally ( cross-flexion/ horizontal
adduction) across the body.
+ test: sudden jerk or clunk as the humeral
head slides off ( subluxes ) the back of
glenoid

8. Circumduction Test
Standing. The examiner stands behind the
pt. grasping the pt’s FA w/ the hand. The
examiner begins circumduction by extending
the pt’s arm while maintaining slight
abduction.
+ test: if the examiner palpates the post.
Aspect of the pt’s sh. As the arm moves
downward in forward flexion & adduction, the
humeral head will be felt to sublux
posteriorly.

Tests For Inferior &
Multidirectional

1. Test for Inferior Shoulder
Instability ( Sulcus Sign )
The pt. stands w/ the arm by the side & sh.
Muscles relaxed. The examiner grasps the
FA below the elbow & pulls the arm distally.
+ test: sulcus sign
Sulcus sign grading: from the inf. Margin of
the acromion to the humeral head.
+1 sulcus implies a distance of < 1cm
+2 sulcus 1-2cm
+3 sulcus > 3cm

2. Feagin Test
Stands w/ the arm abducted to 90˚ & the
elbow extended & resting on the top of the
examiner’s hands are clasped together
over the pt’s humerus, bet. The upper &
middle thirds. The examiner pushes the
humerus down & forward.
+ test: look of apprehension on the pt’s
face.

3. Rowe Test
For multidirectional Instability
Pt. stands forward flexed 45˚ at the wrist w/
the arms relaxed & pointing at the floor. The
examiner places one hand over the sh. So
that the index & middle fingers sit over the ant.
Aspect of the humeral head & the thumb sits
over the post. Aspect of the humeral head.
The examiner then pulls the arm down slightly.
More traction is applied to the arm, & the
sulcus sign is evident.

1. Neer Impingement Test
The pt’s arm is passively & forcibly fully
elevated in the scapular plane w/ the arm
medially rotated by the examiner.
+ test: pt’s shows pain
Indicates an overuse injury to the
supraspinatus muscle & sometimes to the
biceps tendon.

2. Hawkins-kennedy
The pt. stands while the examiner forward
flexes the arm to 90˚ & then forcibly medially
rotates the sh.
May also be performed of forward flexion
(vertically “circling the shoulder”) or horizontal
adduction ( horizontally “circling the
shoulder”)
+ test: pain indicates for supraspinatus
paratenonitis/ tendinosis

3. Coracoid Impingement Sign
Same as the hawkins-kennedy test but
involves horizontally adducting the arm
across the body 10˚ to 20˚ before doing the
medial rotation.

4. Yocum Test
Modification of coracoid impingment test
Pt’s hand is placed on the opposite sh.
& the examiner elevates the elbow.

5. Impingement Test
Sitting. Examiner takes the arm to 90
abduction & full lateral rotation.
+ test: depends on production of the pt’s
symptoms. Indicates a grade II or III sh.
Lesion based on the Jobe’s
classification

6. Reverse Impingement Sign
( Impingement Relief Test )
Used if the pt. has a (+) painful arc or
pain on lateral rotation.
Supine. The examiner pushes the head
of the humerus inferiorly as the arm is
abducted or laterally rotated.
+ test: if the pain ↓ or disappears when
repeating the movements w/ the
humeral head depressed.
For mechanical impingement under the
acromion

7. Posterior Internal Impingement Test
Supine. The examiner passively abducts the
sh. To 90˚, w/ 15˚ to 20˚ forward flexion &
maximum lateral rotation.
+ test: elicits localized pain in the post.
Shoulder.

8. Internal (medial) Rotation
Resistance Strength Test
(IRRST)
Pt. stands w/ the arm abducted to 90 & laterally
rotated 80 to 85˚. the examiner then applies an
isometric resistance into lateral rotation followed
by isometric resistance into medial rotation.
+ test: pt. who has a (+) impingement test if the
pt. has a good strength in lateral rotation but not
medial rotation & indicates an internal
impingement.
If the pt. exhibits more weakness on lateral
rotation, it indicates a classic external anterior
impingement.

1. Clunk Test
Supine. The examiner places one hand on
the post. Aspect of the sh. Over the humeral
head. The examiner’s other hand holds the
humerus above the elbow. The examiner
fully abducts the arm over the pt’s head. The
examiner then pushes anteriorly w/ the hand
over the humeral head while the other hand
rotates the humerus into lateral rotation.
+ test: clunk or grinding sound & a tear of
larum

2. Anterior Slide Test
Sitting w/ the hands on the waist, thumbs
posterior. The examiner stands behind the pt.
& stabilizes the scapula & clavicle w/ one
hand. With the other hand, the examiner
applies an anterosuperior force at the elbow.
If the labrum is torn, the humeral head slides
over the labrum w/ the a pop or crack, & the
pt. complains of pain.

3. Active Compression Test of O’Brien
Standing w/ the arm forward flexed to 90˚ & the
elbow fully extended. The arm then horizontally
adducted 10˚ to 15˚ (starting position) & medially
rotated so the thumb faces downward. The
examiner stands behind the pt. & applies a
downward eccentric force to the arm. The arm is
returned to the starting position & the palm is
supinated, & the downward eccentric load is
repeated.
+ test: if the pain or painful clicking is produced
inside the sh. In the first part of the tes &
eliminated or ↓ in the 2nd part.

4. Kim Test
Sitting w/ back supported. The arm is
abducted to 90 w/ the elbow supported in 90
flexion. The examiner’s hand, while
supporting the elbow & FA, applies an axial
compression force to the glenoid through the
humerus. While maintaining the axial
compression force, the arm is elevated
diagonally upward using the same hand while
the other had applies a downward &
backward force to the proximal arm.
+ test: sudden onset o post. Sh. Pain & click
for posterior labral tear.

5.Biceps Tension Test
Determines whether a SLAP lesion is
present
Standing, abducts & laterally rotates
the arm 90˚ w/ elbow extended & FA
supinated. The examiner then
applies an eccentric adduction force
to the arm.
+ test: reproduction of the pt’s
symptoms

6. Biceps Load Test
Designed to check the integrity of sup. Labrum.
Supine w/ sh. Abducted to 90 & laterally rotated,
w/ the elbow flexed to 90˚ & FA supinated as it is
for the apprehension or crank test. The examiner
performs an apprehension test on the pt. by
taking the arm into full lateral rotation. If
apprehension appears, the examiner stops
lateral rotation & holds the position. The pt. is
then asked to flex the elbow against the
examiner’s resistance at the wrist.
+ test: apprehension remains or becomes more
painful.

7. SLAP Prehension Test
Sitting or standing. The arm abducted to 90˚
w/ the elbow extended & the FA pronated (
thumb down & sh. Medially rotated). The pt. is
then asked to horizontally adduct the arm. The
mov’t is repeated w/ the FA supinated (thumb
up & sh. Laterally rotated).
+ test: if the pt. feels pain in the bicipital groove
in the first case (pronation) but the pain
lessens or absent in the second case
(supination), the test is consdered (+).

8. Labral Crank Test
Supine or sitting. The examiner elevates the
arm to 160 in the scapular plane. In this
position, an axial load is applied to the
humerus w/ one hand of the examiner while
the other hand rotates the humerus medially
& laterally.
+ test: pain on rotation, especially lateral
rotation w/ or w/out click or reproduction of
pt’s symptoms.

9. Pain Provocation Test
Seated & the arm is abducted to bet. 90˚&
100˚, & the examiner laterally rotates the arm
by holding the wrist. The FA is taken into
maximum supination & then maximum
pronation.
+ test: if the pain provoked in the pronated
position

10. Compression Rotation Test
Supine. The examiner grasps the arm &
flexes the elbow w/ the arm abducted to about
20°. The examiner then pushes or
compresses the humerus in the glenoid by
pushing up on the elbow while the examiner’s
other hand rotates the humerus medially &
laterally.
+ test: snapping or catching sensation when
the humeral head is felt indicates a labral tear
(Bankart or SLAP lesion).

1. Lateral Scapular Slide
Test
Sits or stands w/ the arm resting at the side. The
examiner measures the distance from the base of
the spine of the scapula to the spinous process of
T7-T9, or from T2 to the sup. Angle of the scapula.
The pt. is then tested holding two of four other
positions: 45° abduction ( hands on waist, thumbs
posteriorly), 90° abduction w/ medial rotation, 120°
abduction & 150° abduction.
The distance measured should not vary > 1-1.5cm
(0.5 ton 0.75 inch) from the original measure.

2. Wall Pushup Test
Stands arms length from a wall. The pt. is
then asked to do a “wall pushup” 15 to 20
times. Any weakness of the scapular
muscles or winging shows up w/ 5 to 10
pushups.

3. Scapular Retraction Test
Standing. The examiner, standing behind the
pt., places the fingers of one hand over the
clavicle w/ the heel of the hand over the spine
of the scapula to stabilize the clavicle &
scapula & to hold the scapula retracted. The
examiner’s other hand compresses the
scapula against the chest wall.

4. Scapular Isometric Pinch( Squeeze Tes
Standing & asked to actively “pinch” or
retract the scapulae together as hard
as possible & hold the position for as
long as possible.
Normally, an individual can hold the
contractions for 15 to 20 seconds w/ no
burning pain or obvious muscle
weakness.
If burning pain occurs in < 15 seconds,
the scapular retractors are weak.

5. Scapular Assistance Test
Standing. The examiner places the fingers of one
hand over the clavicle w/ the heel of the hand
over the spine of the scapula. The examiner’s
other hand holds the inferior angle of the
scapula. As the pt. actively abducts or forward
flexes the arm, the examiner stabilizes & pushes
the inferior medial border of the scapula up &
laterally while keeping the scapula retracted.
+ test: ↓ pain, it indicates that the scapular
control muscles are weak as the assistance by
the examiner simulates the activity of serratus
anterior & lower trapezius during elevation.

1. Acromioclavicular Shear
Test
Sitting. The examiner cups his/her
hands over the deltoid muscle, w/
one hand on the clavicle & one hand
on the spine of the scapula. The
examiner then squeezes the heels of
the hands together.
+ test: abnormal mov’t at the
acromioclavicular jt.

2. Acromioclavicular Crossover,
Crossbody, or Horizontal Adduction
Test
Pt. stands & reaches the hand across to the
opposite shoulder. The examiner passively
forward flexes the arm to 90° & then
horizontally adducts the arm as far as
possible.
+ test: localized pain over the
acromioclavicular jt.

3. Ellman’s Compression Rotation
Test
Pt. lies on the unaffected side. The
examiner compresses the humeral
head into the glenoid while the pt.
rotates the shoulder medially &
laterally.
If pt’s symptoms are reproduced, GH
arthritis is suspected.

1. Crank Test
Test is done w/ the arm by the side
(superior GH ligament & capsule)
At 45° to 60° abduction (middle GH
ligament, coracohumeral ligament,
inferior GH ligament (ant. Band) &
anterior capsule)
Over 90° abduction (inferior GH ligament
& anterior capsule)

2. Posterior Inferior GH Ligament Test
Pt. sits while the examiner forward flexes
the arm to bet. 80 to 90 & then
horizontally adducts the arm 40 w/ medial
rotation. While doing the mov’t, the
examiner palpates the posteroinferior
region of the glenoid.
+ test: protrusion of the humerus or pain is
felt in the area.

3. Coracoclavicular Ligament
Test
Side lying on the unaffected side w/ the hand
resting against the lower back. The examiner
stabilizes the clavicle while pulling the inferior
angle of the scapula away from the chest
wall. Trapezoid is tested w/ the same
position. The examiner stabilizes the clavicle
& pulls the medial border of the scapula away
from the chest wall.
+ test: pain in either case in the area of the
ligament ( anteriorly under the clavicle bet.
The outer one- third & inner two-thirds).

Test For Muscle
or
Tendon Pathology

1. Speed’s Test ( Biceps or Straight-Arm
Test )
The examiner resists shoulder forward flexion
by the pt. while the patient's FA is first
supinated, then pronated, & the elbow is
completely extended.
may be performed by forward flexing pt's arm
to 90° & then asking the pt. to resist an
eccentric movement into extension first with
the arm supinated, then pronated.
+ test: elicits ↓ tenderness in the bicipital
groove especially w/ the arm supinated & is
indicative of bicipital paratenonitis or
tendinosis.

2. Yergason’s Test
pt's elbow flexed to 90° & stabilized against the
thorax & w/ the forearm pronated, the examiner
resists supination while the pt. also laterally
rotates the arm against resistance.
If the examiner palpates the biceps tendon in the
bicipital groove during the supination & lateral
rotation movement, the tendon will be felt to "pop
out" of the groove if the transverse humeral
ligament is torn.
+ test: Tenderness in the bicipital groove alone
without the dislocation may indicate bicipital
paratenonitis/tendinosis.

3. Ludington’s Test
The pt. clasps both hands on top of or behind
the head, allowing the interlocking fingers to
support the weight of the upper limbs. The pt.
then alternately contracts and relaxes the
biceps muscles. While the pt. does the
contractions and relaxations, the examiner·
palpates the biceps tendon.
A positive result indicates that the long head
of biceps tendon has ruptured.

4. Gilchrest's Sign
While standing, the pt. lifts a 2- to 3-kg (5-
to 7-lb) weight over the head. The arm
laterally rotated fully & lowered to the side
in the coronal plane.
+ test: discomfort or pain the bicipital
groove. Indicates bicipital paratenonitis or
tendinosis.

5. Lippman’s Test
The pt. sits or stands the examiner holds the
arm flexed to 90° with one hand. With the
other hand, the examiner palpates the bicep
tendon 7 to 8 cm (2.5 to 3 inches) below the
glenohumeral joint & moves the biceps
tendon from side to side in the bicipital
groove.
+ test: sharp pain indicates bicipital
paratenonitis or tendinosis.

6. Heuter's Sign
Normally, if elbow flexion is resisted when the
arm is pronated, some supination occurs as
the biceps attempts to help the brachialis
muscle flex the elbow. This supination
movement is called Heuter's sign. If it is
absent, the distal biceps tendon has been
disrupted

7. Supraspinatus ("Empty Can"
or Jobe) Test
The pt's arm is abducted to 90° with neutral
(no) rotation & the examiner provides
resistance to abduction. The shoulder is
then medially rotated & angled forward
30°(empty can position) so that the patient's
thumbs point toward the floor in the plane of
the scapula.
+ test: weakness or pain

8. Drop-Arm (Codman's)
Test.
The examiner abducts the pt's shoulder to
90° & then asks the pt. to slowly lower the
arm to the side in the same arc of movement.
+ test: pt. is unable to return the arm to the
side slowly or has severe pain when
attempting to do so. It indicates a tear in the
rotator cuff complex.

9. Abrasion Sign
The pt. sits & abducts the arm to 90° with
the elbow flexed to 90°. The pt. then
medially & laterally rotates the arm at the
shoulder. Normally, there are no signs &
symptoms.
If crepitus occurs, it is a sign that the
rotator cuff tendons are frayed & are
abrading against the under surfaces of the
acromion process and the coracoacromial
ligament.

10. Lift-Off Sign
The pt stands & places the dorsum of the hand on
the back pocket or against the midlumbar spine.
The pt. then lifts the hand away from the back.
+ test: An inability to do so indicates a lesion of the
subscapularis muscle. Abnormal motion in the
scapula during the test may indicate scapular
instability.
If the pt. is able to take the hand away from the
bank, the examiner should apply a load pushing the
hand toward the back to test strength of the
subscapularis & to test how the scapula acts under
dynamic loading. With a torn subscapularis tendon,
passive (and active) lateral rotation ↑.

If the pt’s hand is passively medially
rotated as far as possible & the pt. is
asked to hold the position, it will be
found that the hand moves toward the
back (subscapularis or medial rotation
“spring back” or lag test) because
subscapularis cannot hold the position
due to weakness or pain.
Also called Modified Lift Off Test.

11. Abdominal Compression (Belly-Press T
Standing. The examiner places a hand on the
abdomen so that the examiner feel how much
pressure the pt. is applying to the abdomen. The pt.
places his or her hand of the of the shoulder being
tested on the examiner’s hand pushes the hand as
hard as he or she can into the stomach (medial
shoulder rotation). While pushing the hand into the
abdomen, the pt. attempts to bring the elbow
forward to the scapular plane causing greater
medially shoulder rotation.
+ test: unable to maintain the pressure on the
examiner’s hand while moving the elbow forward or
extends the shoulder. Indicates a Tear of the
subscapularis muscle.

12. Lateral Rotation Lag Sign
(Infraspinatus “Spring Back” Test)
Seated or standing w/ the arm by the side &
the elbow flexed to 90°. The examiner
passively abducts the arm in the scapular
plane, laterally rotates the shoulder to the
end range, & asks the pt. to hold it.
+ test: the pt. cannot hold the position & the
hand springs back anteriorly toward midline,
indicating infraspinatus & teres minor cannot
hold the position due to weakness or pain.

13. Hornblower’s (Signe de Clairon)
Sign
Also called Patte Test
Standing. The examiner elevates the pt’s
arm to 90° in the scapular plane. The
examiner then flexes the elbow to 90, & the
pt. is asked to laterally rotate the shoulder
against resistance.
+ test: unable to laterally rotate the arm &
indicates a tear of teres minor.

14. Infraspinatus Test
The patient should be standing, with the
arm in a neutral position and the elbow
flexed to 90 degrees. The therapist will
apply a medially directed force to the arm
while the patient is instructed to resist.
+ test: if the patient reports pain or
weakness when resistance is applied.

15. Teres Minor Test
Pt. lies prone & places the hand on the
opposite posterior iliac crest. The pt. is
then asked to extend & adduct the
medially rotated arm against resistance.
+ test: pain or weakness indicates a teres
minor strain.

16. Trapezius Weakness
Sits down & places the hands together over the
head. The examiner stands behind the pt. &
pushes the elbows forward.
Upper trapezius- by elevating the shoulder w/
the arm slightly abducted or to resisted shoulder
abduction & head side flexion .
Middle trapezius- pt. in prone position w/ the arm
abducted to 90° & laterally rotated. The test
involves the examiner resisting horizontal
extension of the arm watching for retraction of
the scapula, w/c should normally occur.
If scapular protraction occurs, the middle trapezius are
weak.

Lower trapezius- pt. is in prone lying w/
arm abducted to 120° & the shoulder
laterally rotated. The examiner applies
resistance to diagonal extension &
watches for scapular retraction that should
normally occur.
If scapular protraction occurs, the lower
trapezius is weak.
If scapula is elevated more than normal, it
may indicate a tight trapezius or the presence
of cervical torticollis.

17. Serratus Anterior Weakness
Standing & forward flexes the arm to 90°. The
examiner applies a backward force to the
arm.
If SA is weak or paralyzed, the medial border
of the scapula will wing ( classic winging ).
The pt. will also have difficulty abducting or
forward flexing the arm above 90° w/ a weak
SA, but it still may be possible w/ lower
trapezius compensation.

18. Rhomboid Weakness
Prone or sitting w/ the test arm behind the
body so the hand is on the opposite side. The
examiner places the index finger along under
the medial border of scapula while asking the
pt. to push the shoulder forward slightly
against resistance to relax the trapezius. The
pt. then asked to raise the FA & hand away
from the body.
If the rhomboids are normal, the thumb is
pushed away from under the scapula.

19. Latissimus Dorsi Weakness
Standing w/ the arms elevated in the
plane of the scapula to 160°. Against
resistance of the examiner, the pt. is
asked to medially rotate & extend the
arm downward as if climbing a ladder.

20. Biceps Tightness
Supine w/ the shoulder in extension over the
edge of the examining table w/ the elbow
flexed & FA supinated. The examiner then
extends the elbow, w/c would normally have
a bone to bone end feel if the biceps is
normal.
If the biceps is tight, full elbow flexion will not
occur & the end feel will be muscular tissue
stretch.

21. Triceps Tightness
Sitting. The arm is fully elevated through
forward flexion & lateral rotation. While
stabilizing the humerus, the examiner flexes
the elbow.
Normally, end feel would be soft tissue
approximation.
If the triceps is tight, elbow flexion will be
limited & the end feel will be muscular tissue
stretch.

22. Pectoralis Major
Contracture Test
Supine & clasps the hands together
behind the head. The arms then lowered
until the elbows touch the examining
table.
+ test: if the elbows do not reach the
table & indicates a tight pectoralis major
muscle.

23. Pectoralis Minor Tightness
Supine. The examiner places the heel of the
hand over the coracoid process & pushes it
toward the examining table.
Normally, the posterior mov’t occurs w/ no
discomfort to the pt., & the scapula lies flat
against the table. However, if there is
tightness over the pectoralis minor during the
posterior mov’t, the test would be considered
positive.

24. Tightness of Latissimus Dorsi,
Pectoralis Major, & Pectoralis Minor
Supine & asked the pt. to fully elevate the
arms through forward flexion.
If the 3 muscles have normal length, the
arm will extend to rest against the
examining table, it indicates that the pecs
minor, pecs major, or lats is tight.

Tests For
Neurological
Function

1. Upper Limb Tension Test
ULTT 1 ULTT 2 ULTT 3 ULTT 4
Shoulder Depression &
abduction ( 100°)
Depression &
abduction
(10°)
Depression &
abduction
(10°)
Depression &
abduction (10°-
90°), hand to
ear
Elbow Extension Extension Extension Flexion
Forearm Supination Supination Pronation Supination
Wrist Extension Extension Flexion &ulnar
deviation
Extension &
radial deviation
Fingers &
thumb
Extension Extension Flexion Extension
Shoulder -------- Lateral
rotation
Medial
rotation
Lateral rotation
Cervical Spine Contralateral side
flexion
Contralateral
side flexion
Contralateral
side flexion
Contralateral
side flexion
Nerve Bias Median &
Anterior
Interosseous
nerve, C5, C6,C7
Median &
musculocutan
eous nerve,
axillary nerve
Radial nerve Ulnar nerve, C8
& T1 nerve
roots

Tests for Thoracic
Outlet Syndrome

1. Roos Test (EAST)
Stands & abducts the arm to 90°, laterally rotates
the shoulder, &flexes the elbows to 90° so that
the elbows are slightly behind the frontal plane.
The pt. then opens & closes the hands slowly for
3 mins.
Unable to keep the arms in the starting position
for 3 mins. of suffers ischemic pain, heaviness or
profound weakness of the arm, or numbness &
tingling of the hand during the 3 mins.
Sometimes called positive abduction & external
rotation (AER) position test, the “hands up” test,
or the elevated arm stress test (EAST)

2. Wright Test or Maneuver
Sitting. Hyperabducting the arm so that the
hand is brought over the head w/ the elbow &
arm in the coronal plane w/ the shoulder
laterally rotated.
Having the pt. take a breath or rotating or
extending the head & neck may have an
additional effect. The pulse is palpated for
differences.

3. Modified Wright Test or Maneuver
( Allen Maneuver )
Sitting. The examiner flexes the pt’s
elbow to 90° while the shoulder is
extended horizontally & rotated laterally.
The pt. then rotates the head away from
the test side. The examiner palpates the
radial pulse, w/c becomes absent
(disappears) when the head is rotated
away from the test side.
+ test: pulse disappearance

4. Costoclavicular Syndrome
(Military Brace) Test
Examiner palpates the radial pulse &
then draws the pt’s shoulder down &
back.
+ test: absence of pulse
This test is particularly effective in pts.
Who complain of symptoms while
wearing a backpack or heavy coat.

5. Provocative Elevation
Test
Pt. elevates both arms above the
horizontal & is asked to rapidly open &
close the hands 15 times.
+ test: if fatigue, cramping, or tingling
occurs during the test, the test is positive
for vascular insufficiency & TOS.
Modification of the Roos Test.

6. Shoulder Girdle Passive
Elevation
Sits & the examiner grasps the pt’s arms
from behind & passively elevates the
shoulder girdle up & forward into full
elevation ( a passive bilateral shoulder
shrug ), & the position is held for 30 or
more seconds.

7. Adson Maneuver
The examiner locates the radial pulse. The
pt’s head is rotated to face the test shoulder.
The pt. then extends the head while the
examiner laterally rotates & extends the pt’s
shoulder. The pt. is instructed to take a deep
breath & hold it.
+ test: disappearance of the pulse

8. Halstead Maneuver
The examiner finds the radial pulse &
applies a downward traction on the test
extremity while the pt’s neck is
hyperextended & the head is rotated to the
opposite side.
+ test: absence or disappearance of a
pulse.

Shoulder - Special Tests

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