Shoulder Integrity Tests

• Shoulder Special Tests - Integrity Tests:

  • test the integrity of the passive joint structures
  • in unstable shoulders, this will produce pain, apprehension and/or excessive mobility
  • tests:
  • apprehension/relocation test (anterior instability)
  • posterior apprehension test (posterior instability)
  • sulcus test (inferior instability)
• Shoulder Special Tests - Integrity Tests:

  • apprehension test:
  • tests for: anterior instability
  • subjective features: pain and apprehension in elevation, especially abduction/external rotation (ABER)
  • start point: in lying, make sure humerus is supported enough to prevent extension. hold pts hand in neutral rotation
  • handling: shoulder is passively laterally rotated slowly. note the point where pts report pain and/or apprehension, then return to start position. repeat the test with AP pressure applied to humerus, near joint line.
  • positive test: greater external rotation range with AP pressure
• Shoulder Special Tests - Integrity Tests:

  • posterior apprehension test:
  • test for: posterior instability
  • typical subjective features: pain and apprehension in forward flexion or weightbearing
  • start point: with pts supine, stabilise scapula with one hand. place other hand over flexed elbow and passively flex shoulder to 90 degrees
  • handling: apply posterior force on pts elbow while horizontally adducting and internally rotating the arm
  • positive test: apprehension and familiar pain
• Shoulder Special Tests - Integrity Tests:

  • inferior sulcus test:
  • tests for: inferior instability of glenohumeral joint
  • typical subjective features: pain and apprehension in caudad forces such as carrying a bag
  • start position: pts seated, place one hand around the elbow and other around the acromion
  • handling: longitudinal caudad force to humerus
  • positive: sulcus or gap appears under acromion
• Shoulder Special Tests - Integrity Tests:

  • Labral Test - Active Compression Test pt 1:
  • reliability is low
  • typical subjective features: pain with movement associated with a click or clunk
  • start point: arm is flexed to 90 degrees, elbow extended. horizontally adduct arm across the chest 10 degrees and thumb pointing down. therapist resists elevation. test is repeated with the thumb pointing up
  • handling: apply posterior force on pts elbows while horizontally adducting and internally rotating arm
• Shoulder Special Tests - Integrity Tests:

  • Labral Test - Active Compression Test pt 2:
  • positive test: if theres pain +/- clicking felt anteriorly/inside shoulder in thumb down position and reduced in thumb up position. pain felt superiorly in thumb down position and reduced in thumb up position can be indicative of acromioclavicular pathology
• Shoulder Special Tests - Integrity Tests:

  • Capsule Length - Posterior Capsule Length Test pt1:
  • tests for: posterior capsule of the glenohumeral joint
  • typical subjective features: pain with movement associated with a click or clunk
  • start point: pts supine, stand to side of bed facing pts
  • handling: stabilise scapula with one hand, with other, bring glenohumeral joint to 90 degrees flexion and full internal rotation. bring into horizontal flexion until you feel the scapula start to move. compare range of movement between sides
• Shoulder Special Tests - Integrity Tests:

  • Capsule Length - Posterior Capsule Length Test pt2:
  • positive test: reduced range of movement prior to scapula moving indicates a tight posterior capsule indicates a tight posterior capsule indicates a tight posterior capsule