**3. Clinical examination and tests**

Clinical examination of the shoulder joint and surrounding area is extremely important in clinching the diagnosis. After preliminary inspection to check muscle wasting, any scars, sinuses, and doing palpation to see tender points, we move on to specific tests. There are various special tests to diagnose the specific condition or pathology [7, 8]:

Instability tests—The apprehension test, load and shift test, crank test, jerk test, sulcus sign test, and the relocation test are some of the most commonly used instability tests of the

Introductory Chapter: Shoulder Joint http://dx.doi.org/10.5772/intechopen.76187 7

Apprehension test—The patient is in sitting or standing position and at 90° of abduction; the examiner applies slight anterior pressure to the humerus and externally rotates the arm. In

Relocation test—The test is performed after the positive result on anterior apprehension test. The patient is in supine or sitting position. The examiner applies posterior force on the proximal humerus while externally rotating the patient's arm. The test is positive if the patient

Crank test—Shoulder is elevated to 160° in the scapular plane, a gentle axial load is applied through glenohumeral joint with one hand, while other hand does internal and external rotation. Positive test is when patient has pain, catching, or clicking in the shoulder. This test is

Biceps and SLAP lesion tests—Speed's test, the O'Brien test, and the biceps load II test are the

Speed's test—The patient is in sitting or standing position; the examiner asks him to forward flex the shoulder against resistance while maintaining the elbow in extension and the forearm in supination. In positive test, the patient will have pain into the biceps region and tender in

**3.1. Rotator cuff tests are described in respective chapters in detail**

humeral head.

expresses relief.

for posterior instability.

positive test the patient expresses apprehension.

three most useful tests for biceps pathologies.

bicipital groove (bicipital tendinitis) (**Figure 7**).

**Figure 7.** Speed test for Biceps pathologies.

Impingement tests—The most popular tests are the Jobe, Hawkins, and Neer tests.

Jobe test is performed with the patient in supine or sitting position, and overhead abduction and external rotation are done. It is positive if the patient reports pain posteriorly, and it indicates posterosuperior glenoid impingement.

Hawkins test—The patient is in standing position; the examiner forward flexes the shoulder to 90°, and then forcibly internally rotates the arm. If the test is positive, the patient will have pain in the area of superior GH joint or AC joint, and it is an indication for subacromial impingement; the test will be negative in case of internal impingement (**Figure 6**).

Neer test—This test is carried out in patient with seated and arm at side, palm down (pronated), Examiner stabilizes scapula and raises the arm (between flexion and abduction). Positive test indicates pain.

Pain at the front of the shoulder is an indication for subacromial impingement, whereas patients with internal impingement will exhibit pain at the posterior aspect of the shoulder.

**Figure 6.** Hawkins impingement test.

Instability tests—The apprehension test, load and shift test, crank test, jerk test, sulcus sign test, and the relocation test are some of the most commonly used instability tests of the humeral head.

Apprehension test—The patient is in sitting or standing position and at 90° of abduction; the examiner applies slight anterior pressure to the humerus and externally rotates the arm. In positive test the patient expresses apprehension.

Relocation test—The test is performed after the positive result on anterior apprehension test. The patient is in supine or sitting position. The examiner applies posterior force on the proximal humerus while externally rotating the patient's arm. The test is positive if the patient expresses relief.

Crank test—Shoulder is elevated to 160° in the scapular plane, a gentle axial load is applied through glenohumeral joint with one hand, while other hand does internal and external rotation. Positive test is when patient has pain, catching, or clicking in the shoulder. This test is for posterior instability.

## **3.1. Rotator cuff tests are described in respective chapters in detail**

Biceps and SLAP lesion tests—Speed's test, the O'Brien test, and the biceps load II test are the three most useful tests for biceps pathologies.

Speed's test—The patient is in sitting or standing position; the examiner asks him to forward flex the shoulder against resistance while maintaining the elbow in extension and the forearm in supination. In positive test, the patient will have pain into the biceps region and tender in bicipital groove (bicipital tendinitis) (**Figure 7**).

**Figure 7.** Speed test for Biceps pathologies.

**3. Clinical examination and tests**

6 Advances in Shoulder Surgery

cates posterosuperior glenoid impingement.

indicates pain.

**Figure 6.** Hawkins impingement test.

Clinical examination of the shoulder joint and surrounding area is extremely important in clinching the diagnosis. After preliminary inspection to check muscle wasting, any scars, sinuses, and doing palpation to see tender points, we move on to specific tests. There are vari-

Jobe test is performed with the patient in supine or sitting position, and overhead abduction and external rotation are done. It is positive if the patient reports pain posteriorly, and it indi-

Hawkins test—The patient is in standing position; the examiner forward flexes the shoulder to 90°, and then forcibly internally rotates the arm. If the test is positive, the patient will have pain in the area of superior GH joint or AC joint, and it is an indication for subacromial

Neer test—This test is carried out in patient with seated and arm at side, palm down (pronated), Examiner stabilizes scapula and raises the arm (between flexion and abduction). Positive test

Pain at the front of the shoulder is an indication for subacromial impingement, whereas patients with internal impingement will exhibit pain at the posterior aspect of the shoulder.

ous special tests to diagnose the specific condition or pathology [7, 8]:

Impingement tests—The most popular tests are the Jobe, Hawkins, and Neer tests.

impingement; the test will be negative in case of internal impingement (**Figure 6**).

**Figure 8.** Yergason's test for Biceps.

The O'Brien test—The patient is in sitting position, and the patient's shoulder is in 90° forward flexion, adduction, and internal rotation; the examiner applies downward force. Positive result is when patient will have pain to the anterosuperior or posterosuperior part of the shoulder indicating superior labral tear.

Biceps load II test—This test is considered positive if the patient complains of pain during the resisted elbow flexion. The patient is in standing position, and the examiner forward flexes the arm to 90°, abducting 15–20° with elbow straight with full internal rotation so the thumb is pointing down, and applies downward force on the arm which the patient resists. Then, the patient externally rotates the arm so that the thumb is pointing up; the examiner applies downward force on the arm, and the patient resists it. The test is positive if pain or painful clicking will be elicited with the thumb down and decreased or eliminated with the thumb up (**Figure 8**).
