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TEXTBOOK & JOURNAL

NOVEMBER 2016

PHYSICAL EXAMINATION OF THE SHOULDER

Nur Syafawati Halim


C111 11 875
Nurul Insyira
C111 11 869
St. Nursyamsiah
C 111 11 174
Advisors:
dr. Alfa Januar
dr. Ery Wildan
dr. Michael Benjamin

Supervisor:
dr. A. DHEDIE PRASETYA, M.KES, SP.OT

ORTHOPEDIC AND TRAUMATOLOGY DEPARTMENT


HASANUDDIN UNIVERSITY
PHYSICAL EXAMINATION
OF THE SHOULDER
ANATOMY
ANATOMY
ANATOMY
Physical Examination of the Shoulder

LOOK
FEEL
MOVE
SPECIAL
TESTS
LOOK

Examine as soon as patient entering the


examination room:
• Arm support (protection of shoulder)
• Swinging
• Swelling, asymmetry, muscle atrophy and
scars
FEEL
(anterior view)
FEEL
(posterior view)
FEEL
(lateral view)
MOVE
SPECIAL TESTS
 Drop Arm Test
 Resisted External Rotation
 Resisted Internal Rotation
 Empty Can Test
 Liftoff Test
 Hawkin’s Test
 Neer’s Test
 Cross Arm/Adduction/Appley’s Scarf Test
 Speed Test
 Yergason’s Test
 O’Brien Test
 Apprehension Test
 Relocation Test
 Surprise Test (Anterior Release)
 Belly Press Test
SPECIAL TESTS
 Drop Arm Test
 Resisted External Rotation
 Resisted Internal Rotation
 Belly Press Test
 Liftoff Test
 Empty Can Test
 Hawkin’s Test
 Neer’s Test
 Cross Arm/Adduction/
Appley’s Scarf Test
 O’Brien Test
 Speed Test
 Yergason’s Test
 Apprehension Test
 Relocation Test Patient : Sit or stand
 Surprise Test Examiner : Abduct arm to 90° in the coronal plane then
(Anterior Release)
horizontally adduct to 45° and ask patient to slowly lower arm
Positive test: Severe pain, or patient unable to lower arm in a
controlled manner on affected side
Consisten with: Rotator cuff tear or significant tendinopathy
SPECIAL TESTS
 Drop Arm Test
 Resisted External Rotation
 Resisted Internal Rotation
 Belly Press Test
 Empty Can Test
 Liftoff Test
 Hawkin’s Test
 Neer’s Test
 Cross Arm/Adduction/
Appley’s Scarf Test
 Speed Test
 Yergason’s Test
 O’Brien Test
 Apprehension Test
 Relocation Test
 Surprise Test Patient: begins sitted with elbow at side and flexed to 90°.
(Anterior Release)
Patient actively externally rotates shoulder
Examiner : stand at side and actively resist external rotation
Positive test: patient has weakness and/or pain on affected side
Consisten with: Rotator cuff or posterior deltoid disfunction
SPECIAL TESTS
 Drop Arm Test
 Resisted External Rotation
 Resisted Internal Rotation
 Belly Press Test
 Empty Can Test
 Liftoff Test
 Hawkin’s Test
 Neer’s Test
 Cross Arm/Adduction/
Appley’s Scarf Test
 Speed Test
 Yergason’s Test
 O’Brien Test
 Apprehension Test Patient : sits, elbows at sides, elbow flexed, actively internally
 Relocation Test rotates shoulder.
 Surprise Test
(Anterior Release) Examiner : stand at side and actively resist internal rotation at
distal forearm
Positive test: patient has weakness and/or pain on affected side
Consistent with: Rotator cuff tendinopathy and/or subscapularis
disfunction
SPECIAL TESTS
 Drop Arm Test
 Resisted External Rotation
 Resisted Internal Rotation
 Belly Press Test
 Liftoff Test
 Empty Can Test
 Hawkin’s Test
 Neer’s Test
 Cross Arm/Adduction/
Appley’s Scarf Test
 O’Brien Test
 Speed Test
Patient : Patient’s palm against the abdomen, with the arm in the
 Yergason’s Test
 Apprehension Test coronal plane and the elbow flexed to 90°
 Relocation Test Examiner : Examiner’s hand is pleased between the patient’s hand and
 Surprise Test abdomen, so that the strength of the subsequent pressure can be felt.
(Anterior Release)
The patient is then instructed to press the hand firmly against the
abdomen.
Positive test: The pressure will be weak and the patient will often move
the elbow forward from the coronal plane in an attempt to gain more
leverage
Consistent with: significant subscapularis weakness
SPECIAL TESTS
 Drop Arm Test
 Resisted External Rotation
 Resisted Internal Rotation
 Belly Press Test
 Liftoff Test
 Empty Can Test
 Hawkin’s Test
 Neer’s Test
 Cross Arm/Adduction/
Appley’s Scarf Test
 O’Brien Test
 Speed Test
 Yergason’s Test Patient : stands or lies prone, the arm is internally rotated and
 Apprehension Test
 Relocation Test
elbow is moderately flexed, with the dorsum of the and touching
 Surprise Test the mid-lumbar spine
(Anterior Release) Examiner : instruc patient to lift the hand away from the back
Positive test: inability to lift the dorsum of the hand off the back
again gravity or minimal resistant from examiner, or restriction is
noted compared with contralateral side
Consistent with: weakness of the subscapularis, latissimus dorsi,
or rhomboids
SPECIAL TESTS
 Drop Arm Test
 Resisted External Rotation
 Resisted Internal Rotation
 Belly Press Test
 Liftoff Test
 Empty Can Test
 Hawkin’s Test
 Neer’s Test
 Cross Arm/Adduction/
Appley’s Scarf Test
 O’Brien Test
 Speed Test
 Yergason’s Test
 Apprehension Test
Patient : shoulders abducted to 90° and angled forward 30°,
 Relocation Test elbows fully extended, and forearms fully pronated (thumbs
 Surprise Test down as if turning a can upside down)
(Anterior Release)
Examiner : apply downward force to the patient distal forearm,
while patient attempt to resist.
Positive test: patient shoulder pain is reproduced
Consistent with: Supraspinatus tendinopathy
SPECIAL TESTS
 Drop Arm Test
 Resisted External Rotation
 Resisted Internal Rotation
 Belly Press Test
 Liftoff Test
 Empty Can Test
 Hawkin’s Test
 Neer’s Test
 Cross Arm/Adduction/
Appley’s Scarf Test
 O’Brien Test
 Speed Test
 Yergason’s Test Patient : flexes elbow and shoulder to 90° withy shoulder
 Apprehension Test
 Relocation Test internally rotated such that the fist is down.
 Surprise Test Examiner : stabilize the patient’s arm by holding proximal to
(Anterior Release)
the elbow while applying tension on the anterior distal
forearm to maximally internally rotate the shoulder
Positive test: reproduces patient’s shoulder pain in the area of
the acromion
Consistent with: impingement syndrome
SPECIAL TESTS
 Drop Arm Test
 Resisted External Rotation
 Resisted Internal Rotation
 Belly Press Test
 Liftoff Test
 Empty Can Test
 Hawkin’s Test
 Neer’s Test
 Cross Arm/Adduction/
Appley’s Scarf Test
 O’Brien Test
 Speed Test
 Yergason’s Test
 Apprehension Test
 Relocation Test
 Surprise Test Patient : extends elbow and pronates forearm (thumbs down)
(Anterior Release) Examiner : lift the patient’s arm in flexion and 30° in the
coronal plane, passively extending the shoulder to end range.
Positive test: patient’ shoulder pain is reproduced
Consistent with: impingement syndrome
SPECIAL TESTS
 Drop Arm Test
 Resisted External Rotation
 Resisted Internal Rotation
 Belly Press Test
 Liftoff Test
 Empty Can Test
 Hawkin’s Test
 Neer’s Test
 Cross Arm/Adduction/
Appley’s Scarf Test
 O’Brien Test
 Speed Test
 Yergason’s Test
 Apprehension Test
 Relocation Test Patient : sits or stands
 Surprise Test Examiner : flexed shoulder to 90° and bring arm horizontally
(Anterior Release)
acrossed the chest so the arm is moved towards the contralateral
shoulder. The examiner feels the ipsilateral acromioclavicular
(AC) joint .
Positive test: pain, shifting, or a click at the AC joint
Consistent with: acromioclavicular dysfunction
SPECIAL TESTS
 Drop Arm Test
 Resisted External Rotation
 Resisted Internal Rotation
 Belly Press Test
 Liftoff Test
 Empty Can Test
 Hawkin’s Test
 Neer’s Test
 Cross Arm/Adduction/
Appley’s Scarf Test
 O’Brien Test
 Speed Test
 Yergason’s Test Patient : positions upper limb with shoulder flexed to 90°, horizontally adducted
 Apprehension Test to 15° and maximally internally rotated and elbow fully extended
 Relocation Test Examiner :
 Surprise Test 1. Apply the downward force to the distal forearm against maximal resistent of
(Anterior Release) the patient
2. The above is repeated with shoulder externally rotated
Positive test: pain or audible click at the acromioclavicular joint or at the
glenohumeral joint
Consistent with: acromioclavicular joint dysfunction if pain in AC joint, or
superior labral anterior posterior (SLAP) pathology if pain at the glenohumeral
joint
SPECIAL TESTS
 Drop Arm Test
 Resisted External Rotation
 Resisted Internal Rotation
 Belly Press Test
 Liftoff Test
 Empty Can Test
 Hawkin’s Test
 Neer’s Test
 Cross Arm/Adduction/
Appley’s Scarf Test
 O’Brien Test
 Speed Test
 Yergason’s Test
 Apprehension Test
 Relocation Test Patient : flexes shoulder to 50°, with elbow in extension and
 Surprise Test wrist in supination
(Anterior Release)
Examiner : provide downward force on the arm to attempt to
extend the patient’s shoulder
Positive test: pain in the area of the bicipital tendon
Consistent with: bicipital tendonitis
SPECIAL TESTS
 Drop Arm Test
 Resisted External Rotation
 Resisted Internal Rotation
 Belly Press Test
 Liftoff Test
 Empty Can Test
 Hawkin’s Test
 Neer’s Test
 Cross Arm/Adduction/
Appley’s Scarf Test
 O’Brien Test
 Speed Test
 Yergason’s Test
 Apprehension Test
 Relocation Test Patient : sits on exam table or chair with the arm resting at
 Surprise Test
(Anterior Release) side; elbow flexed to 90° and forearm pronated.
Examiner : grabs patient’s forearm just proximal to the wrist
and resist active supination
Positive test: pain located in the bicipital groove
Consistent with: bicipital tendonitis/ tendinopathy
SPECIAL TESTS
 Drop Arm Test
 Resisted External Rotation
 Resisted Internal Rotation
 Belly Press Test
 Liftoff Test
 Empty Can Test
 Hawkin’s Test
 Neer’s Test
 Cross Arm/Adduction/
Appley’s Scarf Test
 O’Brien Test
 Speed Test Patient :
 Yergason’s Test 1. Lies on table, with arm hanging off edge.
 Apprehension Test 2. Shoulder is abducted to 90°, elbow flexed to 90°, and shoulder maximally
 Relocation Test externally rotated.
 Surprise Test
Examiner : furthur externally rotate shoulder by applying posteriorly directed
(Anterior Release)
force on the distal forearm with one hand and anterior force on the proximal
arm. Do not go beyond the patient’s pain threshold
Positive test: reproduces the patient’s pain or gives the patient the
“apprehension” of reproduction of their pain or the feeling that their shoulder
will dislocate or “ pop out of the socket”
Consistent with: anterior shoulder laxity or instability
SPECIAL TESTS
 Drop Arm Test
 Resisted External Rotation
 Resisted Internal Rotation
 Belly Press Test
 Liftoff Test
 Empty Can Test
 Hawkin’s Test
 Neer’s Test
 Cross Arm/Adduction/
Appley’s Scarf Test
 O’Brien Test
 Speed Test Patient :
 Yergason’s Test 1. Lies on table, with half of arm hanging off edge.
 Apprehension Test 2. Shoulder is abducted to 90°, elbow flexed to 90°, and shoulder
 Relocation Test
 Surprise Test
maximally externally rotated.
(Anterior Release) Examiner :
1. Stabilize patient’s arm by holding the wrist
2. With the palm of the hand, direct a posterior force to the
glenohumeral joint
Positive test: pain and/or sense of shoulder instability decreases or the
range of motion increases.
Consistent with: anterior shoulder laxity or instability
SPECIAL TESTS
 Drop Arm Test
 Resisted External Rotation
 Resisted Internal Rotation
 Belly Press Test
 Liftoff Test
 Empty Can Test
 Hawkin’s Test
 Neer’s Test
 Cross Arm/Adduction/
Appley’s Scarf Test
 O’Brien Test
 Speed Test
 Yergason’s Test Patient :
 Apprehension Test
 Relocation Test
1. Lies on table, with half of arm hanging off edge.
 Surprise Test 2. Shoulder is abducted to 90°, elbow flexed to 90°, and
(Anterior Release)
shoulder maximally externally rotated.
Examiner : perform relocation test and then suddenly release
force on glenohumeral joint
Positive test: return of symptoms of pain or instability
Consistent with: anterior shoulder laxity or instability
THANK YOU