小温肩关节检查法

BicepsLoadTest:Thistestassessestheintegrityofthesuperiorlabrum.

Patientissupinewithshoulderabductedto90degreesandexternallyrotated,andforearmissupinated.Therapistpassivelyexternallyrotatestheshoulderuntilthepatientbecomesapprehensive.Rotationisstoppedandthetherapistresistselbowflexionwhileinthisposition.Ifapprehensiondecreasesorthepatientfeelsmorecomfortable,thetestisnegativeforaSLAPlesion.Ifpainstaysthesameorworsensandapprehensionremains,thetestisconsideredpositive

BicepsLoadTestII:ThistestisalsousedtoassessforaSLAPlesion

Patientpositionissameasthebicepsloadtestexceptarmisabductedto120degrees.Elbowisbentto90degreesofflexion,forearminsupination.Therapistmovesarmtoendrangeexternalrotation.Inthisposition,theexaminerresistselbowflexion.Painduringflexionisapositivesign

CrankTest:Thistestisusedtoevaluatethedifferentglenohumeralligamentsorforanteriorshoulderinstability.Thistestmayalsobeusedtoassessalabraltear

Withthesubjectstanding,theexaminerplacesthedistalhandonthesubject’selbowandtheproximalhandonthesubject’sproximalhumerusandthenpassivelyelevatesthesubjectsshoulderto160degreesinthescapularplane.Withthedistalhand,theexaminerappliesaloadalongthelongaxisofthehumeruswhiletheproximalhandexternallyandinternallyrotatesthehumerus

DropArmTest:Totestforsupraspinatustears

“Patientisseatedwithexaminertothefront.Examinergraspsthepatient’swristandpassivelyabductsthepatient’sshoulderto90degrees.Examinerreleasesthepatient’sarmwithinstructionstoslowlylowerthearm.Testispositiveifthepatientisunabletolowerhisorherarminasmooth,controlledfashion

FullCanTest:Thistestassessesforsupraspinatuspathology.

Patientisseatedorstandingwitharmraisedinthescapularplaneto30-45degrees(someauthorssuggest90degreedwithshoulderexternallyrotated.Thetherapistappliesadownwardforcejustproximaltothepatient’swristwhilethepatientresists.Testispositiveifitelicitspainand/orweakness.:Apositivetestindicatesateartothesupraspinatustendonormuscleandcanalsoindicateaneuropathyofthesuprascapularnerve.

Thepatientactivelyabductsthearmto90degreeswiththethumbsupwhichmakesthefullcanposition.Theexaminerthenprovidesdownwardpressureonthearmtotestthepatient’sstrength.Thepatientthenelevatesthearmsto90degreesandhorizontallyadducts30degreestothescapularplanewiththumbsdowntotheemptycanposition.Theexaminerprovidesdownwardpressuretotestthepatient’sstrengthinthisposition.Apositivetestforrotatorcufftearismoreweaknessintheemptycan,patientcomplaintofpain,orboth.

Hawkins-KennedyImpingementTest:

Thepatientstandswhiletheexaminerforwardflexesthearmto90degreesandthenforciblymediallyrotatestheshoulder.Thetestmaybeperformedindifferentdegreesofforwardflexionorhorizontaladduction

HorizontalAdductionTest:TestsforACjointdamageorsub-acromialimpingement

Withthepatientinasittingpositiontheexaminerstandswithonehandontheposterioraspectoftheshouldertostabilizethetrunkandtheotherhandholdingthesubjectselbowofthearmbeingtested.Withthetrunkstabilizedtheexaminerpassivelymovestheshoulderintomaximumhorizontaladduction

Hornblower’sSign(PatteTest):Thistestisusedtodeterminethestrengthoftheteresminor1.

Boththetherapistandthepatientarestanding.Thetherapistelevatesthepatient’sarmto90degreesinthescapularplane.Thetherapistthenflexestheelbowto90degrees,andthepatientisaskedtolaterallyrotatetheshoulder.Apositivetestoccurswithweaknessand/orpain

InfraspinatusTest:Thistestassessesforinfraspinatusstrain

Thepatientstandswiththearmatthesidewiththeelbowat90degreesandthehumerusmediallyrotatedto45degrees.Thetherapistappliesamedialrotationforcethatthepatientresists.Painortheinabilitytoresistmedialrotationindicatesapositivetestforaninfraspinatusstrain

JerkTest:Testsforposteriorinstability/tornposteriororposteroinferiorlabrum

Withthepatientseatedtheexaminergraspstheelbowwithonehandandthescapularwiththeotherandelevatesthepatient’sarmto90°ofadductionandinternalrotation.Followingthistheexaminerprovidesanaxialcompressionloadtothehumerusthroughtheelbowmaintainingthehorizontallyabductedposition.Thecompressionforceismaintainedastheexaminermovesthearmintohorizontaladduction.Apositivetestisindicatedbysharppainintheshoulderwithorwithoutaclickingsound

Lift-offSign:Totestforalesionofthesubscapularismuscleandscapularinstability

Thepatientstandsandplacesthedorsumofthehandagainstmid-lumbarspine.Thepatientthenliftshishandawayfromtheback.Aninabilitytoperformthisactionindicatesalesionofthesubscapularismuscle.Abnormalmotionofthescapuladuringthetestmayindicatescapularinstability

LoadandShiftTest:Thistestisusedtocheckforcapsularlaxity.

Patientseatedwitharmslightlyabducted(andsupportedonpillowonlapwithelbowatapproximately90degrees).Examinerstabilizesthescapulainonehandandgraspsthehumeralheadintheotherhand,approximateshumeralheadintoglenoidfossaandappliesananteriorandposteriorforce.Excessivemovementindicateslaxityofthecapsule.Typically,thehumeralheadmovesapproximately25%ofthediameterofthehumeralhead.GradeIlaxityisindicatedby25-50%andgradeIIlaxityisindicatedbygreaterthan50%

O’BrienTest:ThistestisusedtoassessforaSLAPlesion

Thepatientsitswiththetestshoulderin90degreesofforwardflexion,40degreesofhorizontaladduction,andmaximalinternalrotation.Theexaminerstandswithonehandgraspingthesubject’swrist.Thepatienthorizontallyadductsandflexesthetestshoulderagainsttheexaminer’smanualresistance.Thetestisthenrepeatedwiththesubject’sarminanexternallyrotatedposition.Painorpoppingintheinternallyrotatedposition(butnotintheexternallyrotatedpotition)isapositivetest

PosteriorApprehensionTest:Testsfordislocationorposteriorinstabilityofthehumerus

Thepatientshouldbesupineorsittingwhiletheexaminerelevatesthepatient’sshoulderintheplaneofthescapulato90°whileusingtheotherhandtostabilizethescapula.Theexaminerthenappliesaforceposterioronthepatientselbowwhilehorizontallyadductingandinternallyrotatingthearm.Apprehensionisapositivesign

RentSign/Test:Testsforatornrotatorcufforrotatorcuffimpingement

Havethepatientseatedwitharmrelaxedandstandtotherearofthepatient.Theexaminerpalpatesanteriortotheanterioredgeoftheacromionwithonehandwhileholdingthepatient’sflexedelbowwiththeother.Theexaminerpassivelyextendstheshoulderwhileslowlyrotatingtheshoulderintoexternalandinternalrotation.Thegreatertuberositywillbeprominentandadepressionofabout1fingerwidthwillbefeltifarotatorcufftearispresent

Speed’sTest(Bicepsorstraightarmtest)：Thistestlooksforbicepsmuscleortendonpathology

Thepatient’sarmisforwardflexedto90degreesandthenthepatientisaskedtoresistaneccentricmovementintoextension,firstwiththearmsupinated,thenpronated.Apositivetestelicitsincreasedtendernessinthebicipitalgroove,especiallywiththearmsupinated

Yergason’sTest：Thistestisusedtochecktheabilityofthetransversehumeralligamenttoholdthebicepstendoninthebicipitalgroove

Patientsitswhileexaminerstandsinfront.Thepatient’selbowisflexedto90degreesandtheforearmisinapronatedpositionwhilemaintainingtheupperarmattheside.Patientisinstructedtosupinatearmwhileexaminerconcurrentlyresistsforearmsupinationatthewrist.Localizedpainatthebicipitalgrooveindicatesapositivetest

SupineImpingementTest：Thistestisusedtoscreenforshoulderimpingement

Patientisinasupinepositionwithexamineratthesideoftheinvolvedarm.Examinergraspsthepatient’swristanddistalaspectofthehumerusandelevatesthepatient’sarmtoendrange.Examinermovesthepatient’sarmintoexternalrotationandadductsthearmtothepatient’sear.Next,theexaminerinternallyrotatesthearm.Apositivetestisindicatedbysignificantincreaseinshoulderpain

ACShearTest:Totestforacromioclavicularpathology

Thepatientisinsittingpositionwhiletheexaminercupshisorherhandsoverthedeltoidmusclewithonehandontheclavicleandtheotheronthespineofthescapula.Theexaminerthensqueezestheheelsofthehandtogether.Abnormalmovementisapositivetest.

Apley’sScratchTest:Testsforlimitationsinmotionsoftheupperextremity.Eachmotionisperformedbilaterallytocompare.

Action1:Thesubjectisinstructedtotouchtheoppositeshoulderwithhis/herhand.ThismotionchecksGlenohumeraladduction,internalrotation,horizontaladductionandscapularprotraction.

Action2:Thesubjectisinstructedtoplacehis/herarmoverheadandreachbehindthenecktotouchhis/herupperback.ThismotionchecksGlenohumeralabduction,externalrotationandscapularupwardrotationandelevation.

Action3:Thesubjectputshis/herhandonthelowerbackandreachesupwardasfaraspossible.Thismotionchecksglenohumeraladduction,internalrotationandscapularretractionwithdownwardrotation

ApprehensionTestAnteriorShoulder:Thistestchecksforapossibletornlabrumoranteriorinstabilityproblem

Theexaminerstandseitherbehindorattheinvolvedside,graspsthewristwithonehandandpassivelyexternallyrotatesthehumerustoendrangewiththeshoulderin90degreesofabduction.Forwardpressureisthenappliedtotheposterioraspectofthehumeralheadbytheexaminerorthetable(ifthepatientisinsupine).Apositivetestforanteriorinstabilityisifapprehensionispresentedbythepatientorifthepatientreportspain.

AbdominalCompression(Belly-Press)Test:Testsforsubscapularislesion-especiallyforpatients whocannot mediallyrotatetheshoulderenoughtotakeitbehindtheback.

Theexaminerplacesahandontheabdomensothattheheorshecanfeelhowmuchpressurethepatientisapplyingtotheabdomen.Thepatientplaceshisorherhandoftheshoulderbeingtestedontheexaminer’shandandpushesashardasheorshecanintothestomach.Thepatientalsoattemptstobringtheelbowforwardinthescapularplanecausinggreatermedialshoulderrotation.Itisapositivetestifthepatientisunabletomaintainthepressureontheexaminer’shandwhilemovingtheelbowforwardorifthepatientextendstheshoulder.