Shoulder Examination Tests
Numerous clinical tests described for shoulder examination.
Many similar tests have been described by different people and given different names. Also, many different tests have been described by the same person. This can cause confusion.
So far, I have tried to collect as many of the tests I can find and list them here. So far I have found 129 .
I hope to add descriptions, videos and references for the tests soon. If you have a description, reference or even a test not listed here, please contact us .
Also, some of the descriptions or names below might be incorrect. Please contact us if you find inaccuracies below.
SHOULDER CLINICAL TESTS
129 (so far)
General Shoulder Pathology
- Mazion Shoulder Maneuver - -Pt. Seated, Pt. Places hand on opposite shoulder, moves elbow to forehead - (+)intensifies & localized pain
- Codman Sign - tests passive motion of shoulder. Examiner stands behind patient and stabilises scapula with one hand, whilst other hand holds patient's arm and moves arm in every direction. In early stages of cuff disease only active motion is reduced, but later passive motion reduces.
- Palm Sign and Finger Sign Test - Patient demonstrates their pain in two ways: with palm of opposite hand over acromion (= subacromial or GHJ pain), or with opposite finger over ACJ (= ACJ pathology)
- Dugas - Pt. Seated & instructed to place hand on opposite shoulder and touch elbow to chest - (+)pain & inablility to perform indicates dislocation
- Calloways - -measure girth of affected shoulder & compare to unaffected -(+)increased girth indicates dislocation
- Bryants Sign - look for lowering of axillary fold - (+)dislocation on low side
- Anterior Load and Shift (laxity test) -
- Anterior Drawer Test ( Gerber-Ganz Anterior Drawer Test) - Pt. is supine and arm abducted over edge of couch. Examiner immobilisers scapula with one arm whilst the other grasps the arm and pulls it anteriorly.
- Anterior Apprehension
- Jobe Relocation (Fulcrum Test) - Original Article
- Rowe Test - Pt. bends forward slightly with the arm relaxed.The examiner move the arm slightly inferior and anterior by pulling on the forearm
- Throwing Test - Pt. executes a throwing motion against the examiners resistance. Anterior subluxation may occur.
- Leffert Test - Examiner displaces the humeral head anteriorly holding the humeral head over the shoulder with the thumb posteriorly and index finger anteriorly. Displacement of the index finger is positive
- Surprise/Release Test - This manoeuvre is variously described but essentially is the fmal component of the apprehension and relocation tests. It is an extremely provocative test and should be used with caution. As in the Jobe relocation tests the patient's arm is maximally externally rotated with a posteriorly directed force applied to the humeral head. At the limit of range the examiner suddenly removes the posteriorly directed force from the relocation test and again a feeling of apprehension is considered a positive test. (courtesy of Jo Gibson, specialist shoulder therapist, Liverpool)
- Dynamic Anterior Jerk Test - The test combines of a compression force and a translation force, applied along the arm between the humeral head and the glenoid cavity. In so doing, a subluxation of the humeral head is provoked and it is accompanied with a jerk recognised by the patient as his instability.
- Dynamic Relocation Test
- Dynamic Rotatory Stability Test
- Bony Apprehension Test - identical to the standard apprehension test except that the arm is brought to only 45 of abduction and 45 of external rotation. A positive result should alert the examiner to the possibility of a bony lesion as the cause of symptomatic shoulder instability. (Bushnell BD, Creighton RA, Herring MM. Arthroscopy 2008;24:974–82).
- Kinetic Medial Rotation Test - used to differentiate to help determine whether symptoms are primarily impingement or instability. The subject lies supine with 90deg humeral abduction (hand to the ceiling with the humerus in the plane of the scapula). The assessor places one finger on the coracoid process and one on the humeral head. The subject is asked to actively medially rotate the humerus. The ideal is 70deg rotation without any finger movement. If the coracoid finger moves before 70deg then there is an increase in scapula relative flexibility and impingement risk. If the humeral finger moves before 70deg then there is displacing axis of rotation of the humeral head and an instability risk. If both fingers move forward then there is a combined impingement and instability risk. This test obviously needs to be used with other instability and impingement tests to confirm diagnosis but it is a good rehab indicator for where the primary focus should be. (Comerford MJ, Mottram SL. Manual Therapy 2001;6(1):15–26.)
- Posterior Load and Shift - Posterior Drawer Test
- Gerber-Ganz Posterior Drawer Test- same as anterior drawer except with posterior force.
- Posterior Apprehension test - arm adducted and flexed. Examiner pushes posteriorly - apprehension positive.
- Jerk Test
- Fukuda Test - Elicits a passive posterior drawer sign. The examiner stands with thumb resting on scapula spine and fingers over front of humeral head exerting a posterior force.
- Gagey's Hyperabduction Test
- Sulcus Sign at 0 Degrees
- Sulcus Sign at 90 degrees
- Inferior Apprehension Test - The examiner supports the 90 degree abducted arm with one hand. With the other hand the examiner tries to invoke an inferior subluxation by applying pressure downward on the patients upper arm.
- Kibler's Corkscrew test - for core instability
- O'Brien's Test
- Anterior Slide Test (Kibler) - Pt sitting with hands on hips and thumbs pointing posteriorly. Examiner places on hand on top of affected shoulder and other hand on point of elbow. Examiner then applies a forward and superior force on the elbow. Pt asked to resist this force. Pain over the front of the shoulder or a click is positive. (Kibler, Arthroscopy, 1995)
- Posterior Slide Test
- Luddington's Test - hands on top of head & push down
- Curtain's Test (Martin Holt) - opening curtain with arm in 90 deg abduction
- Kibler's grind test
- LaFosse AERS Test - Ab duction Supination External Rotation
- SLAPprehension Test - Original Article
- Feagin Test
- Biceps Load Test 1
- Biceps Load Test 2 - Original Article
- "Crank Test" - performed with the patient lying and elevating the shoulder with the elbow flexed at 90 degrees. An axial load is applied while the arm is rotated internally and externally and circumducted. A click associated with pain makes the test positive. This mechanism is similar to the McMurray test for a torn meniscus in the knee.
- O'Driscoll's SLAP Test - Shoulder is placed in the extreme abducted and externally rotated position. From this position a valgus stress is applied and a positive response is signified by pain at the shoulder. (from Krishnan, Hawkins & Adams. The Shoulder and the Overhead Athlete)
- Pain Provocation Test - Examiner places one hand over scapula, whilst other hand hold patient's wrist. The patient's arm is in 90deg. abd & 90deg. ER, with elbow flexed 90deg. Pt. then asked to supinate & pronate the forearm. Pain worse on pronation indicates a SLAP tear. (Mimori et al. Am J Sports Med, 1999)
- The Resisted Supination External Rotation Test - Original Article
- The Passive Compression Test - Original Article - Patient position: lateral decubitus position with affected side up. The examiner standing behind patient, stabilising the affected shoulder by holding the AC joint with one hand and the elbow with the other. The examiner externally rotates the shoulder in 30° of abduction and then pushes the arm proximally while extending the shoulder. Confirmatory findings: pain or a painful click in the glenohumeral joint. Test rationale: with glenohumeral external rotation and extension (late cocking phase), the long head of the biceps tendon is placed under tensile forces while wrapping around the lesser tuberosity and ultimately shifting the superior labrum from the superior glenoid rim. Proximal migration of the humerus aggravates the displacement of the unstable labrum and passively displaces the superior labrum. (Kim YS, Kim JM, Ha KY, et al. Am J Sports Med 2007;35:1489–94).
- Passive distraction test - Patient position: supine. The examiner standing on the affected side of the patient and positions the extremity off the edge of the table, into 150° elevation in the coronal plane, the elbow extended, the forearm supinated, and the upper arm stabilised to prevent humeral rotation. The examner pronates the forearm while maintaining steady position of the humerus. Confirmatory findings: pain reported deep inside the glenohumeral joint either anteriorly or posteriorly. Test rationale: peel-back phenomenon of the superior labrum. (Schlechter JA, Summa S, Rubin BD. Arthroscopy 2009;25:1374–9).
The passive distraction test may be used for ruling in a SLAP lesion while the passive compression test may be used for both ruling in and ruling out a SLAP lesion.
- The Supine Flexion Resistance Test - Original Article
- Clunk 1 Test
- Clunk 2 Test
- Dynamic Shear (Mayo) Test
Rotator Interval Laxity
- Sulcus with shoulder in external rotation (?test name)
Long Head of the Biceps
- Yergasons Test
- Speed's Test - resisted flexion with straight arm forward 90 degrees and externally rotated.
- Ludington's Test - Pt. Seated & places both hands behind head with interlocked fingers, pt. Contracts & relaxes biceps while Dr. feels for tendons-(+)rupture of long heads if Dr. is unable to feel tendon
- Abbot-Saunders - Pt. Seated, passive abduction, external rotation and lowering of arm, Dr. Palpates long head tendon-(+)a palpable click indicates dislocation of biceps tendon
- Transverse Humeral Ligament Test - Pt. Seated, passive abduction of arm with elbow extended, shoulder is then internally rotated & externally rotated, Dr. palpates bicipital groove.-(+)If Dr. feels tendon snap in & out of groove, indicates torn transverse humeral ligament
- Snap Test - test for subluxation of LHB. The examiner palpates the biceps groove with one hand whilst the other hand rotates the shoulder.
- Hueter Sign - Pt. seated with elbow extended and forearm supinated. The asked to flex elbow against resistance. Formation of a biceps 'ball' shows a LHB rupture.
- Duga Sign - where a LHB lesion is present the patient will not be able to touch the contralateral shoulder
- Beru Sign - displacement of LHB can be palpated below the ant. deltoid when biceps is contracted.
- Traction Test - passive extension of the shoulder with the elbow extended and forearm pronated causes pain in the anterior deltoid region along LHB
- Compression Test - Passive elevation of the arm to the end of ROM with continued application of posterior pressure produces pain as a result of compression of LHB betw. acromion and humeral head.
- Anterior/Posterior AC Shear Test -Pt. sitting, examiner cups both hands with one over scapula and one over clavicle and then squeezes. (Davies et al. Phys Sports Med 1981)
- Cross chest Adduction (Scarf / Forced Adduction Test) - the 90 degrees flexed arm on the affected side is forcibly adducted across the chest. - video [from Silliman JF, Hawkins RJ: Clinical Examination of the Shoulder Complex. In Andrews JR, Willk KE (eds): The Athlete's Shoulder. New York, Churchill Livingstone. 1994.]
- Forced Adduction Test on Hanging Arm - the examiner grasps the affected arm with one hand whilst the other hand rests on the patients opposite shoulder. The examiner forcible adducts the hanging affected arm behind the patient's back against the patient's resistance.
- Dugas Test - the seated patient touches the opposite shoulder with the hand
- AC Distraction (Bad cop) Test - place the arm in maximal internal rotation and apply slight pressure upward. A positive test is pain at the top of the shoulder.
- Paxinos Test - The examiner's hand is placed superior to the ipsilateral mid-clavicle. Pressure is applied by the thumb in an anterosuperior direction and inferiorly with the index-middle finger to the midshaft of the clavicle. (from Krishnan, Hawkins & Adams. The Shoulder and the Overhead Athlete)
- see Impingement Presentation
- video of Impingement examination tests
- Neer Sign - pain with passive abd. in scapula plane, shoulder internally rotated - video
- Neer Test - injection test.
- Hawkin's-Kennedy Test - video
- Empty can/ full can test - video
- Copeland Impingement Test - passive abduction pain eliminated with shoulder in external rotation - video
- Horizontal Impingement test - Hawkins in 90deg abduction & no flexion
- Dawburn's Test - Pt. Seated, Dr. palpates painful subacromial bursa, & passively abducts arm-(+). If pain disappears with increasing abduction this indicates bursitis
- Coracoid Impingement Test - pain directly over coracoid with arm passively adducted across chest (distingiush from ACJ scarf test)
- Internal Rotation Resistance Strength Test (IRRST) - The subject is asked to maximally resist first external rotation and then internal rotation with the arm in 90 abduction and 80 ER. (provided courtesy of Mohamed AbdAlla, Egypt)
- Bursitis Sign - Examiner palpates anterolateral subacromial region. Pain = positive for bursitis.
- Impingement Relief Test - the patient abducts arm through full motion five times and indicates painful arc. The examiner then applies an inferior and posterior force on the humeral head during the painful phase, which relieves the impingement pain.
- Scapular Assistance Test - the examiner assists the scapula with their hand to elevate as the patient elevates their arm. This eliminates the impingement mid-arc pain in patients with dynamic / secondary impingement and indicates scapula rehabilitation exercises are required (Rabin et al. J Orthop Sports Phys Ther. 2006)
- Shoulder Symptom Modification Procedure (SSMP) (Jeremy Lewis, 2009) - A series of four clinical tests to guide management - see here
- video of rotator cuff tests
- Apley's Scratch Test - Reach over shoulder to "scratch" between scapula. Measure to which vertebrae thumb can reach
- Jobes Supraspinatus test (also called ' Empy can test ')
- Dawburn's sign - The pain is worse when lowering the arm from overhead
- Sherry Party sign (Roger Emery)
- Codman's Sign (Drop Arm Sign) - A sign seen in the absence of rotator cuff function or when there is a rupture of the supraspinatus tendon: the arm can be passively abducted without pain, but when support of the arm is removed and the deltoid contracts suddenly, the pain produced causes the patient to hunch the shoulder and lower the arm.(E. A. Codman:The Shoulder: Rupture of the Supraspinatus Tendon and Other Lesions in or about the Subacromial Bursa. Boston : Privately printed, 1934. Reprint, Malabar, Florida : Krieger, 1965.)
- Rent Test - Described by Codman. Palpation of a supraspinatus tear through the deltoid. This is accomplished in a relaxed patient at the anterolateral border of the acromion. Sensitivity = 95.7%, specificity = 96.8% (from Wolf et al. JSES 2001 )
- Zero Degree Abduction Test - Patient standing with arms by their side. Reisted abduction causing pain or weakness suggests a rotator cuff tear.
- Ludington Sign - The seated patient asked to place both hands behind the neck. If the patient has to make compensatory motions or is able to place one hand behind the neck only with assistance this may indicate a rotator cuff tear.
- Scapular Retraction Test - setting the scapular in a retracted position improves the supraspinatus strength, optimising a weakened cuff and giving a truer idea of supraspinatus power.
- Burkhead's Thumbs down & Burkhead's Thumbs up (Many thanks to Nicholas Ansell) - These are two alternative tests that can be used to test the integrity of the rotator cuff out of the painful arc. If there is pain on the Hawkin's test, Jobe's test can be difficult to differentiate if the weakness observed is due to true supraspinatus weakness or an inability to maintain the position because of pain.
Burkhead's thumbs up: the examiner places the patient's arm to approximately 60-80 degrees of forward elevation in the scapula plane out of the painful arc. The patient attempts to raise the arm upwards while the examiner resists this movement. If there is pain this can be a sign of impingement due to antero-superior cuff weakness.
Burkhead's thumbs down: the examiner places the patient's arm to approximately 60-80 degrees of forward elevation in the scapula plane out of the painful arc and then pronates the forearm so that the thumb is facing downwards. The patient attempts to raise the arm upwards while the examiner resists this movement. If there is pain this can be a sign of postero-superior cuff weakness.
- The Lateral Jobe Test - consists of the patient holding their arms in 90 degrees abduction in the coronal plane with the elbows flexed at 90 degrees and the hands pointing inferiorly with the thumbs directed medially. A positive test consists of pain or weakness on resisting downward pressure on the arms or an inability to perform the tests. 81% sensitivity, 89% specificity and 91% PPV according to the authors (Gillooly, Chidambaram, Mok, 2010)
- External Rotation Lag Sign
- Infraspinatus Scapular Retraction Test - for infraspinatus weakness (not tear) in the overhead athlete - click here for more
- Internal Rotation Lag Sign Test
- Gerber's Lift off test (Gerber 1991 , Gerber 1996 , Greis 1996 )
- Belly Off Sign - Patient position: seated or standing. The examiner standing in front of the patient while passively moving the affected upper extremity into flexion and maximal internal rotation with the elbow flexed at 90°. The examiner supports the patient’s elbow while the other hand brings the arm into maximal internal rotation placing the palm of the hand on the abdomen. The patient is asked to keep the wrist straight and actively maintain this position of internal rotation as the examiner releases the wrist (maintaining elbow support). Confirmatory findings: the patient is unable to maintain the position, the wrist flexes or lag occurs and the hand is lifted off the abdomen. Test rationale: the subscapularis muscle acts as a strong internal rotator and this test evaluates the integrity of the musculotendinous unit. (Bartsch M, Greiner S, Haas NP, et al. Knee Surg Sports Traumatol Arthrosc 2010;18:1712–17).
- Belly Press / Napoleon Sign - if patient cannot fully internally rotate and push on their belly, elbow will drop backwards if positive. The examiner pushes against the patient's elbows. (Gerber C, Hersche O, Farron A. J Bone Joint Surg Am 1996;78:1015–23).
- Modified Belly Press Test - Patient position: seated or standing with the affected hand
flat on the abdomen and elbow close to the body. The examiner stands on the affected side of the patient and instructs the patient to bring the elbow forward and straighten the wrist. The examiner measures the final belly-press angle of the wrist with a goniometer. Confirmatory findings: belly-press angle difference of 10° between affected and unaffected side. Test rationale: the subscapularis muscle acts as a strong internal rotator and this test evaluates the integrity of the musculotendinous unit. The modified version of this test measures between side differences in the belly-press angle unlike the original belly press test. (Bartsch M, Greiner S, Haas NP, et al. Knee Surg Sports Traumatol Arthrosc 2010;18:1712–17).
- Bear-Hug Test - for subscap - arm across chest holding opp. lat dorsi and try pull arm away (Burkhart & De Beer)
A study by Pennock et al. (AJSM, 2011) showed that there was no difference in the isolation in the subscapularis between these 3 tests for subscap, however it is not known whether different parts of subscap are activated more or less with each test.
- Lateral Jobe Test - Patient position: seated or standing. The examiner instructs the patient to abduct their
affected shoulder to 90° in the coronal plane with the elbow flexed to 90° and the shoulder internally rotated so that the fingers point inferiorly and the thumbs medially. The examiner then applies an inferior force to the distal arm. Confirmatory findings: pain or weakness or inability to perform the test. Test rationale: the author’s did not provide an explanation as to why this test mechanically differs from the original Jobe test. (Gillooly JJ, Chidambaram R, Mok D. Int J Shoulder Surg 2010;4:41–3).
4. Massive cuff tear:
- Hornblower's sign - an inability to externally rotate the elevated arm; demonstrates severe infraspinatus and teres minor weakness.
- The Dropping Sign (Walch) - With a seated patient the shoulder is placed in 0 of abduction, and 45 of external rotation with the elbow flexed to 90. The examiner holds the patient's forearm in this position, instructs the patient to "maintain this position when he lets go of the forearm." On releasing the forearm a positive test is recorded when the patient's forearm drops back to 0 of external rotation, despite the patient's efforts to maintain external rotation.
- French Horn Shoulder Test (Internal & External rotation)
- 90/90 Drop Lag Test
Also see: Comparison of the Hornblowers and Dropping Sign
Internal Impingement Syndrome
- Posterior Impingement Sign - Pt. supine with shoulder in 90 deg. abd and elbow in 90deg flexion. Examiner stabilises elbow and applies ER force to maximum ER.
- Compression test
- GIRD - Glenohumeral Internal Rotation Deficit (Burkhart) - post capsular tightness
Posterior Labral Tear
- Push-Pull Test - The patient is supine and the arm held at the wrist with the shoulder at 90 degrees abduction and neutral rotation. The examiner places the other hand on the proximal humerus and while pulling with the arm holding the patient's wrist, the examiner pushes with the arm on the proximal humerus. This is often enough to maximally translate the patient's humeral head posteriorly. The test is positive if it reproduces the patients symptoms. (from Krishnan, Hawkins & Adams. The Shoulder and the Overhead Athlete)
- Jahnke Jerk Test - Performed seated or supine. The affected arm is placed in maximal horizontal adduction and internal rotation and a posterior force applied. This causes posterior subluxation. Next the shoulder is brought back from horizontal adduction while maintaining posterior force on the humerus at the elow. As the shoulder approaches normal a cluck may herald reduction of the subluxed shoulder, which is a positive test. (from Krishnan, Hawkins & Adams. The Shoulder and the Overhead Athlete)
- Painful Jerk Sign Test
- Kim Test (provided courtesy of Mohamed AbdAlla, Egypt)
- Shoulder Quadrant Test
- Coracoid Impingement Sign - performed with the patient standing with the shoulder abducted 90 degrees with horizontal adduction in the coronal plane and maximally internally rotated (the tennis "follow through" position). (from Krishnan, Hawkins & Adams. The Shoulder and the Overhead Athlete)
- Military Brace Test (Roos Test)
- Brachial Plexus Stretch Test
- SC Joint stress test
- Scapula Pinch / Retraction Test (for scapula stability) - Pt sitting and maximally retracting scapula. Hold for 15 seconds(Kibler Am J Sports Med 1998).
- Thompson and Kopell Horizontal Flexion Test - Standing Pt. moves the 90 degree abducted arm across the body into maximum horizontal flexion. Pain over the back of the scapula indicates possible suprascapular nerve entrapment (same as Scarf test).
- Lateral Scapula Slide Test (LSST) - to determine scapular position with the arm abducted 0, 45, and 90 degrees in the coronal plane. Assessment of scapular position is based on the derived difference measurement of bilateral scapular distances. (Odom et al. Phys Ther. 2001)
- Coracoid Pain Test, for frozen shoulder - pain elicited by pressure on the coracoid (Carbone. Int Orthop. 2010)
- Pectoralis Minor Length Test - used to assess shoulder protraction due to pec minor shortening. Although it is reproducible, it has been shown to have little diagnostic benefit (Lewis & Valentine, 2007).
- Olecranon-manubrium percussion test - Patient position: seated or standing with elbows flexed at 90°. The examiner places the stethoscope bell over the manubrium and percusses each olecranon process. Confirmatory findings: a decrease in pitch or the intensity of the affected side. Test rationale: if there are any bony abnormalities, the affected side should have a duller sound than the normal side. (Adams SL, Yarnold PR, Mathews JJt. Ann Emerg Med 1988;17:484–7).
- Shrug sign - Patient position: standing. The examiner instructs the patient to abduct both arms in the coronal plane. Confirmatory findings: elevation of the scapula or shoulder girdle in order to achieve 90° of abduction. Measured with a goniometer, the magnitude of the shoulder shrug was defined as the angle between the arm and the horizontal point at which the shrug moment began.Test rationale: the authors conclude the shrug sign can detect shoulder abnormalities, especially those associated with loss of range of motion or weakness on manual muscle testing. (Jia X, Ji JH, Petersen SA, et al. Clin Orthop Relat Res 2008;466:2813–19).
Useful Links & Bibliography:
- Clinical Exam Videos (in Real format)
- Myer CA, Hegedus EJ, Tarara DT, et al. A user’s guide to performance of the best shoulder physical examination tests. Br J Sports Med 2013;47:903–907.