Tests for Examination of the Shoulder

Courtesy: Prof Nabil Ebraheim, University of Toledo, Ohio, USA

Clinical Evaluation of the Shoulder

Overview

History – Active & passive ROM – Differentiate shoulder from cervical pain – AC joint – Rotator cuff/subacromial pathology – Glenohumeral instability – Biceps/SLAP lesion

1. General Evaluation

Begin with:

• Detailed history
• Clinical examination
• Active range of motion
• Passive range of motion
• Comparison with the opposite shoulder

Important associated conditions

• Diabetes mellitus
• Hypothyroidism

as conditions associated with adhesive capsulitis.

Clinical principle

Always compare:

Active ROM vs passive ROM, and compare both with the contralateral side.

2. Shoulder Pain vs Cervical Pain

An important early step is deciding whether the symptoms originate from the shoulder or cervical spine.

Feature	Shoulder pain	Cervical pain
Typical location	Posterolateral aspect of deltoid	Trapezius region
Radiation	Not emphasized	May radiate into upper extremity
Cervical provocative test	—	Spurling test

coexisting cervical and shoulder pathology is not uncommon.

3. Spurling Test

Purpose

Assessment of cervical nerve-root compression/impingement.

Technique

The neck is placed in:

Extension + lateral flexion toward affected side + rotation toward affected side

followed by:

Axial compression

Positive test

Reproduction of upper-extremity radicular pain attributable to nerve-root compression.

Exam Pearl

The important positive finding is radiating upper-extremity pain, rather than isolated local neck discomfort.

4. Acromioclavicular Joint

After cervical screening, assess the AC joint.

The main provocative test described is:

Cross-body adduction test

5. Cross-Body Adduction Test

Position

Patient may be:

• Sitting, or
• Standing upright

Technique

The affected arm is brought across the body.

The examiner:

• Pushes the elbow to maximize cross-body adduction
• Palpates the AC joint with the opposite hand

Positive test

Localized pain and tenderness over the AC joint

suggests AC-joint pathology.

6. Subacromial Impingement & Rotator-Cuff Evaluation

tests according to the structure/pathology being evaluated.

Pathology / Structure	Test mentioned
Subacromial impingement	Neer test
Subacromial impingement	Hawkins test
Rotator cuff tear	Drop-arm test
Subscapularis	Belly-press test
Subscapularis	Lift-off test
Infraspinatus	Abduction–external rotation test
Supraspinatus	Jobe test

 

7. Neer Test

Used for:

Subacromial impingement

8. Hawkins test

It is grouped with Neer as a test for subacromial impingement.

 

9. Drop-Arm Test

Used to assess:

Rotator-cuff pathology/tear

 

10. Subscapularis Tests

Belly-Press Test

Used for:

Subscapularis weakness or rupture

Lift-Off Test

Also used for:

Subscapularis weakness or rupture

Subscapularis – Belly press + Lift-off

11. Infraspinatus

Abduction–external rotation test

for assessment of the infraspinatus muscle.

 

12. Supraspinatus — Jobe Test

Jobe test

Used for evaluation of the:

Supraspinatus

Jobe – Supraspinatus

13. Glenohumeral Joint & Instability

• Glenohumeral joint
• Labral/capsular structures
• Shoulder instability

The tests are organized according to the direction of instability.

Test	Pathology assessed
Load-and-shift test	Glenohumeral instability
Anterior apprehension test	Anterior instability
Posterior apprehension test	Posterior instability
Jerk test	Posterior instability
Sulcus test	Multidirectional instability

14. Load-and-Shift Test

Used as a general assessment for:

Glenohumeral instability

15. Anterior Apprehension Test

Used for:

Anterior shoulder instability

16. Posterior Instability

• Posterior apprehension test
• Jerk test

Both are used to assess:

Posterior instability

17. Sulcus Test

The sulcus test is used for:

Multidirectional instability

Sulcus sign – Multidirectional instability

18. Biceps Tendon

Speed test

19. SLAP Lesion

O’Brien test / active compression test,

High-Yield Shoulder Examination Table

Area	Test	What it assesses
Cervical spine	Spurling	Cervical nerve-root compression
AC joint	Cross-body adduction	AC-joint pathology
Subacromial space	Neer	Impingement
Subacromial space	Hawkins	Impingement
Rotator cuff	Drop arm	Rotator-cuff tear
Subscapularis	Belly press	Weakness/rupture
Subscapularis	Lift off	Weakness/rupture
Infraspinatus	Abduction–ER test	Infraspinatus
Supraspinatus	Jobe	Supraspinatus
GH joint	Load and shift	Instability
Anterior instability	Anterior apprehension	Anterior instability
Posterior instability	Posterior apprehension	Posterior instability
Posterior instability	Jerk	Posterior instability
MDI	Sulcus	Multidirectional instability
Biceps	Speed	Biceps tendon pathology
SLAP	Test name unclear in transcript	SLAP pathology

Practical Examination Sequence

1. History

   2. Active and passive ROM + compare opposite side

   3. Rule out cervical pathology — Spurling

   4. AC joint — Cross-body adduction

   5. Impingement — Neer + Hawkins

   6. Rotator cuff — Jobe / Drop arm / Belly press / Lift off / ER testing

   7. Glenohumeral instability — Load-shift + apprehension tests

   8. MDI — Sulcus

   9. Biceps — Speed

   10. SLAP assessment

 

• Always assess both active and passive ROM and compare with the opposite shoulder.
• Diabetes and hypothyroidism are specifically associated with adhesive capsulitis in the lecture.
• Shoulder and cervical pathology can coexist.
• Spurling – cervical nerve-root compression.
• Cross-body adduction – AC joint.
• Neer + Hawkins – subacromial impingement.
• Drop arm – rotator-cuff tear.
• Jobe – supraspinatus.
• Belly press + lift off – subscapularis.
• Load and shift – glenohumeral instability.
• Anterior apprehension – anterior instability.
• Jerk + posterior apprehension – posterior instability.
• Sulcus – multidirectional instability.
• Speed – biceps tendon.

Exam Pearls

For rapid recall:

Neck – Spurling
AC joint – Cross-body adduction
Impingement – Neer + Hawkins
Supraspinatus – Jobe
Subscapularis – Belly press + Lift off
Anterior instability – Apprehension
Posterior instability – Jerk
MDI – Sulcus
Biceps – Speed