Impingement:

1. Neer sign: with one hand stabilize the scapula, behind the patient, and the other hand internally
rotate with elevation of the arm
2. Neer test: sen 72%, spe 60%. The same maneuver after injection of lidocaine, bupivacaine and
steroids.
3. Jobs (empty can test): sen 74% spe 30%, abduct 90 in the scapular plane (30-degree forward
flexion) internally rotate the arm and extend against resistance.
4. Hawkins: sen 80%, spe 56%. Flex the shoulder and elbow to 90-degrees. Then internally rotate.
5. Yocum test: make the patient hold the unaffected shoulder with his palm. Then elevate the
elbow.
6. Painful arc: the patient abducts the shoulder in the scapular plane, positive if the pain from 60-
120 degrees.

Anterior instability:

1. Apprehension (sen 66% spe 95%), relocation (sen 65% spe 40%) and release (sen 82% spe 86%)
tests: while the patient is supine, abduct the shoulder to 90, then maximally externally rotate
(apprehension) he will have pain, then push the femoral head posteriorly (relocation test) the
pain will improve. Then release your hand (release test)
2. Anterior Load and shift: the patient is lying supine, flex the shoulder to 90, and abduct to 40-60.
Then apply axial load and try to subluxate the humeral head anteriorly (anterior load and shift)
and posterior (posterior load and shift).
3. Anterior drawer test: stabilize the scapula with one hand and the head of the humerus with the
other hand, then subluxate it anteriorly (anterior drawer test) and posteriorly (posterior drawer
test).

Multidirectional:

1. Sulcus sign (inferior instability): have the patient stand and apply downward pull on the arm. It is
positive if it +2 at external rotation.

Posterior instability:

1. Miniaci test: patient is sitting, the shoulder is adducted and internally rotated with 70-90 flexion
and apply axial loading. Then abduct and externally rotate.
2. Kim test: sen 80% spe 94%. Abduct the shoulder to 90, apply axial loading with the examiner
belly. Then elevate the elbow while applying downward and posterior pressure on the head of
the humerus. Then adduct the shoulder.
3. Jerk test: sen 90% spe 85%. while the patient is sitting, stand behind him and stabilize the
scapula, abduct the shoulder to 90 and slightly internally rotated and apply axial loading, then
bring the shoulder to horizontal adduction.
4. Posterior load and shift test: see anterior load and shift
5. Posterior stress test: stabilize the scapula with one hand. flex shoulder to 90, adduct and
internally rotate then apply posterior force.
6. Posterior drawer test: see anterior drawer test.

AC joint:
 1. Obrian test (active compression test): patient is standing, flex the shoulder to 90, and adduct 10-
15. Then ask the patient to fully pronate the forearm then push the while he resiste. Then do it
with the forearm is in fully supination.
2. Cross shoulder adduction: the patient will flex the arm to 90 and actively adduct while you
palpating the AC joint.

Subscapularis:

1. Left off test: for the inferior tendons of subscapularis, the patient will bring his hand to his
lumber spine and the palm facing upward. Then he will left off.
2. Internal rotation lag sign: most sen and spe. Stand behind the patient, elbow to 90, abduct to 20
extend to 20 and hold the patient elbow, and maximally rotate the humerus internally and ask
the patient to hold his position. If it drifts it is a positive sign.
3. Belly press test: more accurate for the superior borders of the subscapularis, ask the patient to
press on his belly while his elbow is in front the trunk. If his elbow went posteriorly it is a
positive test.

Supraspinatus:

1. Drop arm sign: passively elevate the arm to 90 in the scapular plane and ask the patient to hold
his position. If it drops it is positive.
2. Jobs test (empty and full can test): see impingement. In addition, you can do the full can test it is
the same, however, do it with his thumbs up.

Infraspinatus:

1. External rotation lag sign: flex the elbow to 90 and maximally externally rotate the shoulder
while the elbows at the side. Ask the patient to hold the position. If it drifts it is positive.

Teres minor:

1. Hornblower sign: bring the shoulder to 90 abduction and maximally external rotation. Ask the
patient to hold the position. If he is unable to hold the position it is positive.

SLAP lesion:

1. Obrian test (active compression test): see AC joint. Sen 67% spe 37%
2. Crank test: abduct the shoulder to 90, then apply axial loading and rotate internally and
externally.

Biceps:

1. Speed test: resist the patient elevation attempts while his in 90 flexion and his palms up.
2. Yergason test: the elbow is in 90 flexion and the forearm is fully pronated. Ask the patient to
supinate against resistance.