Special Tests for Shoulder Injuries 〜Part 1〜

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In order to check which tissues (muscles? tendons? ligaments? bones? or cartilages?) are causing pain, doctors (orthopedists), athletic trainers, and other clinicians listen to patients’ talk about their pains/injuries, palpate the spots, and/or utilize x-ray and MRI to specify injured parts. One of the ways is to perform “Special Tests.”

Research used in this post have investigated which special tests have been frequently used by 71 orthopedists specialized for shoulders in their sites to identify shoulder injuries. From this research, I am going to introduce special tests for shoulder injuries that athletic trainers should know.   

Part 1 includes special tests for “Acromioclavicular joint,” “Impingement syndrome,” “Labrum injuries,” and “Biceps Bracii.” This post included some terminology because it is written for athletic trainers. 

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>>References for this post are below:

scshoFrequency of Use of Clinical Shoulder Examination Tests by Experienced Shoulder Surgeons

An article from Journal of Athletic Training

 

pic for ortho

「Orthopedic and Athletic Injury Examination handbook」

A textbook for an athletic training program I graduated

 

 

 

Acromioclavicular Joint Injury

Only one special test that all orthopedists have used to identify acromioclavicular injuries is “Cross-body Adduction Test.”

 

Cross-body Adduction test

 

1)An athletic trainer stands by an injured shoulder side.

2)Put one hand on the injured shoulder with the fingers placing at the acromioclavicular joint and keep it stable.

3)An another hand holds the elbow and brings it up to 90 degree of shoulder flexion position. 

4)Horizontally adduct it from 90 degree of shoulder flexion position

5)Positive if pain occurs

An acromioclavicular joint injury is suspected if cracking sound is heard or felt from the joint or a space of the joint spreads out.

 

Impingement Syndrome

More than 50% of the orthopedists have used “Neer Test” and “Hawkins-Kennedy Test” to identify impingement syndrom. 

Additionally, one study have reported that impingement syndrome would be suspected if more than 3 special tests are positive from performing 5 special tests, which are Neer Test, Hawkins-Kennedy Test, Painful-Arc test, Empty Can test, and External rotation resistance test.

Two special tests that more than 50% of orthopedists have used are introduced below.

 

Neer Test

 

1)A patient relaxes his/her shoulder and arm. 

2)An athletic trainer stands by the shoulder tested.

3)The athletic trainer holds patient’s elbow and wrist of the arm tested and brings the arm to internal rotation position.

4)Lift the arm up (=shoulder flexion) while keeping it in the internal rotation position. The patient keeps it relaxed all the time during the test.

5)Positive if pain occurs.

 

Hawkins-Kennedy Test

 

1)A patient sits on a chair or table or stands up.

2)An athletic trainer stands by the shoulder tested.

3)Hold the patient’s arm, bring it up to a position of 90-degree shoulder flexion, and bend his/her elbow at 90 degrees. 

4)The patient needs to be relaxed all the time during the test.

5)From the position of 90-degree shoulder flexion and elbow flexion, rotate the shoulder internally (the forearm rotating downward)

6)Positive if pain occurs at the outside of the shoulder. 

 

Glenoid Labral Injury

According to the survey answered by 71 orthopedists, 18 kinds of special tests checking glenoid labral injury have been used. However, Among the 18 kinds of the special tests, only “O’Brian test” has been used by more than 50% of the orthopedists.  

 

O’Brian Test

 

1)A patient should be a sitting or standing position.

2)An athletic trainer brings an arm up to a position of 90-degree shoulder flexion.

3)From that position, add about 20 degrees of shoulder horizontal adduction.

4)Furthermore, rotate the shoulder internally, which makes the forearm pronate as well (the thumb pointed to the floor)

5)Finally, the trainer push the patient’s arm downward (toward the floor). The patient resists the force and keeps the position.

6)Next, rotate the shoulder externally, which makes the forearm supinate (the thumb pointed to the sky)

7)Same as 5), the trainer pushes his/her arm downward. The patient resists the force.

8)Positive if pain or clicking sound occurs at the position of internal rotation of the shoulder and then its pain is relieved at the position of external rotation of the shoulder.

【Cautions】Athletic trainers should not jump to conclusion. The patient may not have a glenoid labral injury even if the O’Brian test is positive.  Frequently, patients with rotator cuff injury, impingement syndrome, or acromioclavicular injury also tests positive by the O’Brian test. 

Athletic trainers should perform several special tests and other clinical tests, such as palpation or patient’s history, to assess and identify injuries.

 

Biceps Brachii Injury

Speed Test” and “Yergason Test” have been performed by many orthopedists to identify biceps brachii injuries. 

 

Speed Test

 

1)A patient should be siting or standing position.

2)The test needs to be started at the neutral position of the shoulder. The patient’s elbow is extended.  

3)An athletic trainer holds the patient’s shoulder tested to stabilize. While holding it, the athletic trainer touches intertubercular groove of the biceps brachii with his/her fingers. 

4)Hold the patient’s wrist by an another hand.

5)The athletic trainer applies downward force to the wrist of the patient.

6)The patient resists the force applied by the trainer.

7)Then, the trainer has the patient slowly bring his/her arm up while still applying the force downward. 

8)Positive if the pain occurs at the spot of the finger touched (intertubercular groove of the biceps brachii).

 

Yergason Test

 

1)A patient should be a sitting or standing position. 

2)A shoulder joint should be a neutral position. An elbow joint is 90-degree flexion and pronation (The thumb should be toward the sky).

3)An athletic trainer holds the patient’s elbow with one hand and grabs his/her wrist with another hand. 

4)The trainer brings the shoulder into the position of external rotation and the forearm into the supination position.

5)The patient resists the force of supination applied by the trainer.

6)Positive if pain or cracking sound occurs at the intertubercular groove.

 

Next, a part-2 is going to introduce special tests for rotator cuff injuries. 

 

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