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Mina Nasser Wagih Under Graduated 3rd year Faculty of Physical Therapy Cairo uni Instability tests : 2 Instability tests Anterior Draw testPatient supine, fix the patient's hand in the axilla, holding the patients scapula with one hand assess the relative movement of the humerus with the other. The shoulder is held in 80 - 120o abduction, 0 - 20o forward flexion and 0 - 30o of external rotation Posterior Draw testPatient supine, examiner grasps the patient's proximal forearm and flexes the elbow to about 120o and positions the shoulder in 80 - 120o of abduction and 20 - 30o forward flexion. With the examiners other hand hold the scapula with the thumb just lateral to the coracoid and thumb the humeral head posteriorly Load and Shift testsLoad humerus into glenoid in 60o abduction and then test anterior, posterior and inferior gliding, plus sulcus test inferiorly Apprehension testTests for shoulder instability. Abduct and ER shoulder to position of instability; patient 'apprehends' if positive Relocation testAfter apprehension test, apply a posterior force by placing a hand in front of shoulder. If the apprehension relieves, is positive Jerk testApply a posterior force to arm, while in 90o flexion and internal rotation. Feel a 'clunk', if positive for posterior subluxation Sulcus signApply an inferior force to arm while at side. If more than 1 cm interval noticed in acromiohumeral space, is positive for inferior/multidirectional laxity Impingement tests : 3 Impingement tests Primary Impingement sign (Neer) Demonstrated by preventing scapular rotation with one hand, while the other hand raises the affected arm in forward and abduction, causing the greater tuberosity to impinge against the acromion Secondary Impingement signPain during abduction of the arm to 90° and internal rotation. Pain can be due to impingement or other pathology, e.g. frozen shoulder, Ca deposition, OA Impingement testIf pain is due to impingement, it will be abolished by injection of 10 ml of 1% lidocaine into the joint Persistence of weakness indicates a complete cuff tear, as pain inhibition abolished. If restoration of the ability to abduct the arm, the cuff tear must be partial Internal Impingement signPut the hand in ABER position and extension. Positive if painful in this position, but painless in ABER with flexion Hawkin's testApply an internal rotation force to arm while in 90o shoulder flexion and 90o elbow flexion. Positive for impingement if painful Impingement tests : 4 Impingement tests Infraspinatus Strength Ninety percent of external rotation depends on infraspinatus strength, and loss of strength in the infraspinatus correlates closely with the size of a rotator cuff tear. Supraspinatus Strength The arms are held in the scapular plane as if pouring out a can of pop ask the patient to forward elevate and assess weakness, test resisted external rotation with the arm by the side. Subscapularis Strength With the supraspinatus and infraspinatus tendons, the subscapularis is part of the rotator cuff. The strength of this is tested by the lift-off test. The patient is asked to hold his hand behind his back at waist level, palm facing out, and move the arm away from the body against pressure from the examiner Labrum / Biceps tendon injuries : 5 Labrum / Biceps tendon injuries Yergason's testDetermines if biceps tendon is stable in bicipital groove. Patient flexes elbow to 90° and forearm is pronated. Grasp the elbow in one hand and the wrist in the other. Patient actively tries to supinate against resistance Speed's testElbow extended and forearm supinated, patient elevates humerus against resistance Crank testInternal and external rotate arm in full abduction. Positive for SLAP lesion if painful Obrien's testApply a downward force to arm while in 90o flexion, 10o adduction and full pronation, then repeat it in full supination. Positive for SLAP lesion if painful in the first maneuver and painless in the second Popeye signBulging of biceps belly in rupture of bicepital tendon Rotator cuff tests : 6 Rotator cuff tests Jobe's testApply a downward force to arm while in 90o abduction, 30o flexion (scapular plane) and fully pronated. Failure to maintain position means supraspinatus weakness/lesion Drop Arm TestDetects if there is any tears in rotator cuff. Instruct patient to fully abduct arm and then slowly lower it in scapular plane to side Hornblower's signPut the arm in 90o abduction and 90o external rotation. Failure to maintain position means teres minor weakness/lesion Rubber band signFlex the elbow 90o, put the arm in slight abduction and full external rotation. Failure to maintain position means infraspinatus weakness/lesion Internal rotation lag signThe most sensitive and specific for subscapular pathology. Flex elbow to 90°, internally rotate shoulder to full at back, lifting the hand away from the lumbar spine. Failure to maintain position or >5o change in position means subscapular weakness/lesion Lift off test Similar to previous test, but the patient rushes away from back against resistnace. Measures subscapularis strength. More accurate for inferior portion of subscapularis. Is confounded by other muscles Belly push testMake the patient press abdomen with both hands, keeping elbows in front of body. Positive for subscapularis weakness/lesion if elbows drop back. More accurate for superior portion of subscapularis Empty Can/Full Can TestJobe and Moynes described by : 7 Empty Can/Full Can TestJobe and Moynes described by The empty can test assesses the supraspinatus for instability and the presence of tears. The test is conducted as follows: The patient raises his arm to 90 degrees and angles the arm forward 30 degrees at the shoulder joint. The shoulder is then internally rotated as if pouring a can on the floor. Resistance is applied looking for weakness or pain. The test is positive if there is significant pain or weakness or resistance. THANKSDr. Mina Nasser : 8 THANKSDr. Mina Nasser You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.