Shoulder Test
Acromioclavicular Joint
1. Crossover or crossed body ADDuction test.
2. Adduct the patients arm across the chest
3. Pain with adduction is POSITIVE
4. Acromioclavicular joint tenderness and compression
Apley Scratch Test
1. Ask the patient to touch the opposite scapula from above and from the
bottom vice versa
2. From above were testing ABduction and external rotation
3. From the bottom were ADDuction and internal rotation
4. Pain during these maneuvers suggest ROTATOR CUFF DISORDER or
ADHESIVE CAPSULITIS
Painful Arc Test – Pain provocation Test
1. Fully ABduct the patients arm from 0 to 180.
2. Shoulder pain from 60 to 120 is positive for a subacromial impingement or
rotator cuff tendinitis disorder
3. Pain 170 to 180 its acromial clavicular joint disease (OA)
Neer Impingement Sign – Pain provocation Test
1. Press on the scapula to prevent scapular motion with one hand and raise
the patients arm with the other.
2. This compresses the greater tuberosity of the humerus against acromion
3. Pain during this maneuver is positive a subacromial impingement or
rotator cuff tendonitis disorder
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Hawkins Impingement Sign – Pain provocation Test
1. Flex the patient’s shoulder and elbow to 90 with the palm facing down.
Then with one hand on the forearm and one on the arm, rotate internally.
2. This compresses the greater tuberosity against the supraspinatus tendon
and coracoacromial ligament.
3. Pain during this maneuver is positive for supraspinatus impingement or
rotator cuff tendinitis disorder
External Rotation Lag Test – Strength Test
1. With the patient’s arm flexed to 90 with the palm up, rotate the arm into
full external rotation.
2. Inability to maintain the external rotation is positive for supraspinatus and
infraspinatus disorder
Internal Rotation Lag Test – Strength Test
1. Ask the patient to place the dorsum of the hand on the low back with the
elbow flexed to 90. Then lift the hand off the back, which further internally
roates the shoulder.
2. Ask patient to keep hand in this position.
3. Inability to hold the hand in this position is positive for subscapularis
disorder
Drop-arm Test – Strength Test
1. Ask the patient to fully ABduct the arm to shoulder up to 90, and lower in
SLOWLY.
2. Abduction above the shoulder level from 90 – 120 is done by the deltoid
3. Weakness during this maneuver is positive for supraspinatus rotator cuff
injury tear or bicipital tendinitis
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External Rotation Resistance Test – Composite Test
1. Ask the patient to adduct and flex the arm to 90 with the thumbs turned
up. Stabilize the elbow with one hand and apply pressure proximal to the
patient’s wrist as the patient presses the wrist outward in external
rotation.
2. Pain or weakness during this maneuver is positive for infraspinatus
disorder
3. Limited external rotation points to glenohumeral disease or adhesive
capsulitis
Empty Can Test – Composite Test
1. Elevate the arms to 90 and internally rotate the arms with thumbs pointing
down as if emptying a can.
2. Ask the patient resist as you place downward pressure on the arms.
3. Inability of the patient to hold the arm abducted at shoulder level or
control lowering the arm is positive for supraspinatus
Elbow
Cozen Test
1. Stabilize the patient’s elbow and palpate the lateral epicondyle and ask the
patient to pronate and extend the wrist against resistance
2. Pain along the lateral aspect of the elbow indicates lateral epicondylitis
(tennis)
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Wrist
Hand Grip
1. Ask the patient to grasp your second and third fingers
2. This test the wrist joints, finger flexors, and the intrinsic muscles and joints
of the hands.
3. Decreased grip strength is a positive test for weakness of the finger flexors
and/or intrinsic muscles of the hand. It also results from inflammatory or
degenerative arthritis, carpal tunnel syndrome, epicondylitis, and cervical
radiculopathy. Grip weakness plus wrist pain are often present in de
Quervain tenosynovitis.
Finkelstein
1. Ask the patient to grasp the thumb against the palm and move wrist
towards midline in ulnar deviation.
2. Pain during this maneuver identifies de quervian tenosynovitis from
inflammation.
Knee
McMurray Test – Testing Medial & Lateral Meniscus
1. With the patient supine, grasp the heel and flex the knee. Cup your other
hand over the knee joint with fingers and thumb along the medial joint
line.
2. From the heel, externally rotate the lower leg, then push on the lateral side
to apply a valgus stress on the medial side of the joint.
3. At the same time, slowly extend the lower leg in external rotation. The
same maneuver with internal rotation of the foot stresses the lateral
meniscus.
4. If a click is felt or heard at the joint line during flexion and extension of the
knee, or if tenderness is noted along the joint line, further assess the
meniscus for a posterior tear.
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Abduction Stress Test – Valgus – Testing MCL
1. With the patient supine and the knee slightly flexed, move the thigh about
30° laterally to the side of the table. Place one hand against the lateral
knee to stabilize the femur and the other hand around the medial ankle.
Push medially against the knee and pull laterally at the ankle to open the
knee joint on the medial side (valgus stress).
2. Pain or a gap in the medial joint line is a positive test for an MCL injury
Adduction Stress Test – Varus – Testing LCL
1. With the thigh and knee in the same position, change your position so that
you can place one hand against the medial surface of the knee and the
other around the lateral ankle. Push laterally against the knee and pull
medially at the ankle to open the knee joint on the lateral side (varus
stress).
2. Pain or a gap in the lateral joint line points is a positive test for LCL injury
Anterior Drawer Sign – Testing ACL
1. With the patient supine, hips flexed and knees flexed to 90° and feet flat
on the table, cup your hands around the knee with the thumbs on the
medial and lateral joint line and the fingers on the medial and lateral
insertions of the hamstrings. Draw the tibia forward and observe if it slides
forward (like a drawer) from under the femur. Compare the degree of
forward movement with that of the opposite knee.
2. A forward jerk showing the contours of the upper tibia is a positive test, or
anterior drawer sign
3. ACL injuries result from knee hyperextension, direct blows to the knee, and
twisting or landing on an extended hip or knee
Lachman Test Testing ACL
1. Place the knee in 15° of flexion and external rotation. Grasp the distal
femur on the lateral side with one hand and the proximal tibia on the
medial side with the other. With the thumb of the tibial hand on the joint
line, simultaneously pull the tibia forward and the femur back. Estimate
the degree of forward excursion.
2. Significant forward excursion is a positive test for an ACL tear
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Posterior Drawer Sign PCL
1. Position the patient and place your hands in the positions described for the
anterior drawer test. Push the tibia posteriorly and observe the degree of
backward movement in the femur.
2. If the proximal tibia falls back, this is a positive test for PCL injury
3. Isolated PCL tears are less common, usually resulting from a direct blow to
the proximal tibia
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