● Lift-off test : For the lift-off test, the patient places the back of their hand against their lumbar spine then tries to move the hand away from the spine. The test is positive if the patient is unable to move the hand away from the spine. With a sensitivity of 40% and a specificity of 79%, this test is less sensitive and less specific than the belly press test (Cotter et al., 2018). ● Bear hug test : For the bear hug test, the patient places the hand corresponding to the side of the affected shoulder on the contralateral acromioclavicular joint with the hand flat and the fingers extended. The elbow of the affected arm is placed anterior to the body at the height of the shoulder. The patient maintains this position while Two common injuries to the biceps tendons are biceps tendinitis and instability of the long head of the biceps (Cotter et al., 2018). These injuries are common with overhead activities, including throwing, reaching, and washing one’s hair. Swimmers, tennis players, and baseball players are also at risk for biceps tendinitis due to the repetitive nature of their sports’ specific performance activities (Athwal, 2021). The bicipital sling is the capsuloligamentous complex that acts to stabilize the long head of the biceps tendon in the bicipital groove. With partial-thickness tears of the upper border of the subscapularis and/or anterior supraspinatus, this structure can be disrupted, resulting in instability of the long head of the biceps (Cotter et al., 2018). With biceps tendinitis, patients typically report anterior shoulder pain with activities that put the biceps tendon at risk for subluxation or impingement (Cotter et al., 2018). This includes reaching, dressing, and showering. Special tests for biceps Involvement includes: ● The speed test : The speed test is used to assess the long head of the biceps tendon. For this test, the patient’s shoulder is flexed to 90 degrees with the arm fully supinated and the elbow fully extended. The examiner directs a downward force on the arm, which the patient attempts to resist. This test is positive if
the examiner applies an external rotation force to the forearm. The test is positive if the patient demonstrates weakness or is unable to maintain that position. The sensitivity for this test is only 19%, but the specificity is 99% for subscapularis tears. Multiple tests should be used to determine if a rotator cuff tear is present. It has been found that a combination of supraspinatus weakness, external rotation weakness, and impingement with internal or external rotation is highly predictive of rotator cuff tears, with a posttest probability of 98% (Cotter et al., 2018).
BICEPS TENDON INJURIES
anterior shoulder pain is reproduced. This test has a sensitivity of 54% and a specificity of 81% (Cotter et al., 2018). ● The Yergason test : For this test, the client is seated with the elbow against the thorax and flexed to 90 degrees, with the forearm full pronated. The examiner and the patient grasp hands, and the examiner resists the patient as they try to supinate the forearm. The test is considered positive if it results in pain over the bicipital groove or subluxation of the long head of the biceps (Cotter et al., 2018). This test has been shown to have a sensitivity of 41% and a specificity of 79% for biceps pathology. ● The upper cut test: With the upper cut test, the patient’s shoulder is in a neutral position with the elbow flexed to 90 degrees, the forearm supinated, and the hand in a fist. Then the patient moves their fist toward their chin in an “upper cut” motion (like a boxer) while the examiner’s hand is placed over the patient’s hand to resist this upward motion. If pain or a popping sensation is elicited over the anterior part of the shoulder, that is considered a positive upper cut test (Cotter et al., 2018). This test has been shown to have a sensitivity of 73%, a specificity of 77%, and a positive likelihood ratio of 3.38.
SUPERIOR LABRUM ANTERIOR POSTERIOR (SLAP) TEARS
patients between 45 and 60 years of age with asymptomatic shoulders (Cotter et al., 2018). The anterior slide test The patient is seated for this test with their elbow flexed and their hand on the hip with the thumb facing posteriorly. The examiner puts one hand on the superior part of the patient’s shoulder and the other hand on the elbow. The examiner applies an anterior and superiorly directed force to the elbow while simultaneously stabilizing the shoulder. The test is positive if it reproduces the patient’s shoulder pain or if it creates clicking in the anterior shoulder (Cotter et al., 2018). This test has been shown to have a sensitivity of 78% and a specificity of 91% for detecting SLAP tears (Cotter et al., 2018).
Superior labrum anterior posterior tears are in the superior labrum of the shoulder and are anteriorly to posteriorly directed. They are common in patients who regularly perform overhead job duties (e.g., carpenters, electricians, and mechanics) and those who participate in overhead activities such as throwing (e.g., baseball and softball players). In throwers, the mechanism of injury is thought to occur in the late cocking phase of throwing when excessive strain is placed on the bicipitolabral complex, causing, in essence, a “peeling away” of the superior labrum (Cotter et al., 2018). Tests for SLAP tears include the anterior slide test and the aforementioned O’Brien active compression test. A high incidence of SLAP tears has also been found in
ACROMIOCLAVICULAR JOINT SEPARATION
The resisted AC joint extension test can be used to confirm AC joint involvement. Resisted AC joint extension test For this test, the examiner stands behind the seated patient. The examiner places the shoulder in 90 degrees of flexion and internal rotation with the elbow flexed 90 degrees. The examiner puts their hand on the patient’s elbow and asks them to horizontally abduct the arm against isometric resistance. The test is positive if it causes pain in the AC joint (Cook & Hegedus, 2013).
The acromioclavicular (AC) joint is a diarthrodial joint consisting of the convex lateral clavicle and the concave medial acromion. Within the AC joint is a fibrocartilaginous intraarticular disc that functions like the meniscus of the knee (Deans et al., 2019). The acromioclavicular joint is inherently unstable (Cotter et al., 2018). This instability makes it susceptible to separation and degeneration. AC joint separation/sprain is common with car crashes, falls from a bike, and falls while skiing. It is also common in collision sports like football, hockey, and lacrosse. The mechanism of injury is either blunt trauma to an abducted shoulder or a fall on an outstretched hand (Kiel et al., 2022).
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