ORTHO SUMMARIES

Checklist:

 Expose area of assessment

 Perform tests bilaterally
 Start on unaffected side
 Indications
 Contraindications
Anterior Instability

NAME PROCEDURE POSITIVE

Anterior Abd arm 60-80˚ and grasp humeral head. Apply PA force to Pain, apprehension
drawer joint to assess mmt. (https://www.youtube.com/watch? and > 25% ant
v=cH09QPWeyzY) translation

Apprehension Pt supine. Passive abd arm 90˚ and flex elbow. Ext/lat rot Pxn, apprehension
(Crank) w/ arm until pt exp pxn/apprehension. move it back a little and > 25% ant
relocation and apply a PA force to humeral head (pushing it back into translation
glenoid fossa), ideally relieving pxn.
(https://www.youtube.com/watch?v=mM-BPbpLgd8)

Fulcrum Pt supine. Abd pt arm to 90˚ and flex elbow. Scoop hand Pxn, apprehension
under GHJ and ext/lat rot shoulder. and > 25% ant
(https://www.youtube.com/watch?v=mM-BPbpLgd8) translation
Posterior Instability

NAME PROCEDURE POSITIVE

Jerk Pt seated. Flex shoulder to 90˚. Apply AP force to Sudden jerk as
humerus. Abd and add shoulder to elicit possible clunk. humeral head sblx
(https://www.youtube.com/watch?v=fllSbhxF_lU) from post aspect of
glenoid. Possible
clunk.

Posterior Pt supine. Flex shoulder and int/med rot and add shoulder. Pxn, apprehension
apprehension Apply AP force to humerus. Palp post humeral head with and > 50%
other hand to assess posterior translation. translation and
(https://www.youtube.com/watch?v=t8oLGlMprOg) possible clunk.

Multidirectional and Inferior Instability

NAME PROCEDURE POSITIVE

Sulcus sign Pt seated/standing w/ arm resting at side and relax Sulcus formation
shoulders. Dr holds arm below elbow and distract inf. and feeling of
(https://www.youtube.com/watch?v=vV7u2JtdYWI) dislocation. (smile)

Faegin Pt seated/standing w/ arm abd to 90 and rests on Dr Apprehension and

shoulder. Dr clasps humerus at delt insertion. Dr then too much antero-
pushes down and forward. inferior translation.
(https://www.youtube.com/watch?v=qvv9mvRpUCU) (Pt feels like jnt
will sblx)
Anterior Impingement

NAME PROCEDURE POSITIVE

Hawkins- Pt shoulder and elbow flexed to 90 and internally rotated Pain = Supraspin
Kennedy by Dr. Supraspin tendon jams against ant surface of tendonitis
coracoacromial ligament. (depends on
(https://www.youtube.com/watch?v=X9YiuvQJVJc) location)

Neer Pt seated/standing. Dr stand behind pt and quickly raises pt Pain = overuse of

hand in abd/flex while stabilising scapula. Jamming of > supraspin/ biceps
tuberosity on anteroinf acromial surface. Dr contacts ipsilat tendon.
scap.
(https://www.youtube.com/watch?v=nNyax0iocZo)

Zaslav Pt standing w/ arm as if holding a stop sign (90˚ shoulder ↓ strength int rot =
abd and elbow flex). Dr then resists int/med and ext/lat rot. internal
This test differentiates btwn subacromial and intra-articular impingement
impingement. weakness in ext rot
(https://www.youtube.com/watch?v=Hd0rngwsn3Y) = ext ant
impingement.

Supine Pt supine. Dr abd arm as far as possible. Dr ext rot arm and Pain =
impingement abd against ear then int rot arm to narrow subacromial impingement dt
space. rotator cuff
In ext/lat rot, fully flex shoulder, add shoulder. Int/med rot pathology.
shoulder to elicit pxn.
(https://www.youtube.com/watch?v=GJOvrsP984M)

Labral Tests

NAME PROCEDURE POSITIVE

 Active Pt stands w/ arm flexed to 90 and elbow ext. Dr adduct arm Pain = on jnt line
compression 10-15˚ and int rot (thumb down). Dr app downward force w/ painful clicking
test of on arm w/ resist. in shoulder in part
O’Brien Arm then returned to 1st pos and palm supinated. 1 that is decreased
(SLAP lesion) Downward pr from Dr applied again w/ resist. or removed in part
(https://www.youtube.com/watch?v=qkDvVBi0gg8) 2.

Kim test Pt seated. Pt shoulder abd to 90 and elbow flexed to 90˚. Dr Pain and click =
(Posteroinf apply axial force to glenoid through humerus while posteroinferior
labral lesion) elevating diagonally upward while the other hand apply inf labral lesion.
and post force.
(https://www.youtube.com/watch?v=-knsALCdv_A)

AC Joint Pathology

NAME PROCEDURE POSITIVE

Horizontal Pt sit/stand. Dr flex arm to 90 and horizontally add as far as Pain localised over
Adduction possible. ACJ
(https://www.youtube.com/watch?v=DKLvt816x6o) False + = SCJ local
pain
Muscle Pathology Tests

NAME PROCEDURE POSITIVE

Speed’s Pt seated/standing w/ arm flexed 90˚, Tenderness at bicipital groove =
supinated and elbow extended. Dr push biceps tendonitis.
down and pt resists.
(https://www.youtube.com/watch?
v=gbG_O9Gv8aQ)

Drop arm Dr adducts arm to 90. Pt slowly lets it fall to Pt unable to return arm slowly/
rest. has severe pain = rotator cuff
(https://www.youtube.com/watch? tear/tendonitis.
v=JXgRBeqToik)

Supraspinatus Pt stand/seated. Pt shoulder abd to 90˚ in Weakness/pain esp in part 2 =

(empty can) scapular plane and Dr resists. supraspin mm, tendon tear/
Shoulder then int/med rot (thumb face neuropathy of nn supply to
floor). Dr resist abd from pt. supraspin mm
(https://www.youtube.com/watch?
v=DeO50UTxwoo)

Pec major Pt supine and clasps hands behind head. Pt Elbows do not reach table/ one is
contracture relaxes elbows to table. higher than the other = tight pec
(https://www.youtube.com/watch? major.
v=6WSybz0modY)

Infraspinatus Pt stands w/ arm at side and elbow flexed to Pain and inability to resist =
90. Humerus rotated int/med 45˚. Dr infraspinatus tear
applied int rot force, pt must resist.
 (https://www.youtube.com/watch?
v=xVQy0qPU3Ho)

Subscapularis 1. Pt stands and places hands at back 1. Inability to lift hand

(lift off sign) pocket. Lift hands away from back. away = subscapularis
2. Dr resists as pt lifts away. mm lesion
3. Pt asked to hold hands away from Abnormal mmt of
back and hands spring back. scapula = scapular
(https://www.youtube.com/watch? instability.
v=AgkTH52_PBI) 2. Inability to resist = ↓
strength in subscapularis
dt possible tear
3. Pain, weakness = torn
subscapularis

Nerve Pathology

NAME PROCEDURE POSITIVE

Brachial Pt supine. Dr holds pt palm. Abd and ext rot arm Pain/tingling in median nn
plexus behind coronal plane. Other hand fixes shoulder in distrib = stretching of dura
tension test depression. Elbow passively extended w/ wrist held mater in c spine and tension
2 in ext and forearm supinated. Lat flex of c spine can on median nn.
enhance test.
(https://www.youtube.com/watch?
v=fhsrNKWVh0s)