if both sides appear affected) and ask if the client feels a stretch in the pectoralis minor area to confirm their observations. Cross-fiber friction at the coracoid process, as Acromioclavicular (AC) joint shear test This tests for the integrity of the AC joint ligaments. The client should be in a seated position with the therapist standing behind the client. The therapist will interlace their fingers with the palm of one hand on the lateral aspect of the clavicle and the other palm on the client’s lateral spine of the scapula. The therapist then squeezes their hands Adhesive capsulitis abduction test This tests for frozen shoulder at the glenohumeral joint. The client can be seated or standing. The therapist stands behind the client and holds the client’s affected arm above the elbow and at the wrist and attempts to slowly abduct the client’s arm out to 90 degrees. Frozen shoulder is indicated by pain accompanied by a limited ROM (under 90 degrees). The therapist can apply most manual therapy Drop arm test This tests for weakness or dysfunction of either the deltoid or supraspinatus muscle. The client can be seated or standing. The client will abduct their arm to 90 degrees, hold the position for a moment, if possible, then slowly adduct their arm to their body. Weakness or a dysfunction of the deltoid is indicated by pain at the muscle’s attachments or in its belly. Weakness or dysfunction of the supraspinatus Hawkins-Kennedy impingement test Tests for impingement or injury to the supraspinatus tendon. With the client seated or standing, they are asked to abduct their arm to 90 degrees and, keeping their elbow in full extension, medially or downwardly rotate their humerus at Painful arc test This tests for a supraspinatus tendon and subacromial bursa impingement. With the client seated or standing with their arms by their side, the client abducts the affected shoulder through its full ROM, to 180 degrees if possible. A positive result is indicated by pain at, near, or underneath the acromion starting at 70 degrees of abduction and easing after 130 degrees of abduction. Positive results should be referred to a physician or doctor of physical therapy for diagnosis (Cleland et al., 2020). Lateral/external rotators strength test This procedure tests for weakness or dysfunction of the infraspinatus and/or teres minor muscles. With the client seated or standing, they keep their arm by their side while flexing the elbow to 90 degrees. They are then asked to laterally/externally rotate their arm while the therapist resists their motion with internal rotation. A dysfunction of the infraspinatus is indicated by pain in the muscle belly on the posterior scapula. A weakness of infraspinatus is indicated Gerber’s lift-off test This tests for a dysfunction of the subscapularis muscle. The client can be seated, standing, or lying prone on a table with their arm beside them, elbow slightly flexed, with their hand placed on their lower back. The client is asked to lift their hand off their back and maintain this position. A weakness of the subscapularis is indicated if the client is unable to lift their hand off their back. An accompanying
well as PNF stretches, directional massage, and myofascial release may be of use in relieving the hypertonicity (Cleland et al., 2020).
together. Dysfunctional AC joint ligaments are indicated by pain or excessive movement of the joint. The therapist should use cold therapy to reduce pain before attempting cross-fiber friction on the AC joint to initiate tissue repair. Avoid moving the shoulder joint and perhaps stabilize it with a sports wrap or tape (Cleland et al., 2020). technique for the hypertonic muscles around the affected joint but should let the client know that such techniques are not a long-term solution for this condition since its cause is, in most cases, idiopathic (unknown) and affect the joint capsule itself rather than the musculature (Cleland et al., 2020). is indicated by pain above the spine of the scapula or near the greater tubercle of the humerus and may indicate a rotator cuff tear. (See next test.) Weakness, as a symptom of its own, of either muscle is indicated by the client being unable to slowly or smoothly abduct or adduct their arm. Cross-fiber friction at the attachments is effective for these muscles (Cleland et al., 2020). the elbow. A supraspinatus muscle tear or impingement is indicated by pain at, near, or underneath the acromion of the scapula. The client should consult a physician for a diagnosis (Cleland et al., 2020). Healthcare Consideration: Of the four rotator cuff muscles—supraspinatus, infraspinatus, teres minor, and subscapularis—supraspinatus, specifically its distal tendon at the greater tubercle of head of the humerus, is the most common rotator cuff injury. All positive results of orthopedic tests should be diagnosed by a physician or doctor of physical therapy (Cleland et al., 2020). by an inability of the client to maintain strength against the therapist’s resistance. A dysfunction of teres minor is indicated by pain along the superior-lateral border of the scapula high in the axillary. A weakness of teres minor is indicated by an inability of the client to maintain strength against the therapist’s resistance. When pain is present in these muscles, trigger point therapy is highly effective (Cleland et al., 2020). pain deep in the axillary is typically indicative of an injury to the muscle belly or origin, while pain near the lesser tubercle of the humerus may indicate a tear at the muscle’s insertion. Working in the axillary with trigger point therapy can be effective, though challenging due to client sensitivity in this area and the nearby presence of the brachial nerve plexus (Cleland et al., 2020).
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