1. Part 4

2. Special Tests (13)  Biceps tendon tests (6)  Impingement tests (3)  Thoracic outlet tests (4)

3. Yeargason Test (LH biceps):  Examiner begins by positioning the standing pt into 90 degrees of elbow flexion with the arm at the side  Examiner uses one hand to palpate the long head of the biceps and the other at the distal arm to provide resistance  Examiner then instructs pt to attempt to first externally then internally rotate the shoulder as the examiner resists the movement  Test is positive for biceps tendon subluxation (and subsequent tenosynovitis) if pt experiences pain or the examiner notes palpable crepitus.

4. Gilcrest Test (LH biceps):  Pt begins by grasping a 5-pound dumbbell in each hand  Pt is then instructed to externally rotate the shoulder, supinate the wrist, and raise both arms over head  Pain or crepitus at or around the superior glenoid fossa is a positive test that is indicative of tenosynovitis of the long head of the biceps  Pain or crepitus at or around the coracoid process is a positive test that is indicative of tendinitis of the short head of the biceps  Important distinction between long head tenosynovitis and short head tendinitis lies in the fact that only the long head is protected by a tendon sheath

5. Speed’s Sign (LH biceps):  Examiner first palpates the tendon of the long head of the biceps (deep in the anterior deltoid)  Examiner then instructs pt to flex the elbow as the examiner resists  Pain indicates a positive sign for bicepital tenosynovitis

6. Lippman’s Test (LH biceps):  Pt begins with the elbow flexed to 90 degrees and the humerus resting at the side  Examiner palpates the long head of the biceps and moves 3 inches distally  Examiner then rolls the biceps tendon against the humerus  Pain indicates a positive test for long head biceps tendon subluxation

7. Booth & Marvel (Transv. Hum. Lig.) Test (LH biceps):  Examiner passively abducts pt’s arm to 90 degrees and then passively internally and externally rotates pt’s shoulder  At the same time, the examiner maintains pressure on pt’s bicepital groove  Pain or a popping sound or sensation is indicative of a positive test for long head biceps tendon subluxation

8. Ludington’s Test (LH biceps):  Examiner instructs pt to clasp the hands overhead and contract the biceps isometrically  Test is positive for long head biceps tendon subluxation if pt experiences sharp pain on contraction

9. Neer Impingement Test (impingement):  Examiner passively flexes pt’s arm into complete flexion  Pain indicates a positive test for subacromial impingement syndrome

10. Hawkins-Kennedy Test (impingement):  Examiner passively positions pt’s shoulder in 90 degrees of flexion, 90 degrees of elbow flexion, and end-range shoulder internal rotation  Apprehension or sensations of pain are considered a positive test for subacromial impingement syndrome

11. Jam Test (impingement):  Examiner first abducts the standing pt’s arm to 90 degrees and flexes the elbow to 90 degrees  Examiner then internally rotates pt’s arm so that pt’s hand points toward the floor  Next, examiner rapidly and sharply pushes the pt’s elbow with one hand to effectively drive the greater tuberosity under the coracoacromial ligament  Examiner’s other hand should be used to stabilize the shoulder  Test is positive for subacromial impingement syndrome if pt experiences pain

12. Adson Test (thoracic outlet syndrome):  Examiner begins by palpating pt’s radial pulse  Pt’s arm is then abducted, extended, and externally rotated while the examiner continues to palpate the pulse  Pt is then instructed to take a deep breath and turn the head toward the arm being tested  A disappearance of the radial pulse is a positive test that indicates a compression of the subclavian artery by the medial scalene muscle

13. Allen Test (thoracic outlet syndrome):  Pt begins from a standing position  Examiner passively flexes pt’s elbow to 90 degrees, then abducts and externally rotates pt’s shoulder  Examiner then palpates pt’s radial pulse and instructs pt to look away from the side being tested  A disappearance of the radial pulse indicates a positive test for thoracic outlet syndrome

14. Halstead Maneuver (thoracic outlet syndrome):  The examiner first palpates pt’s radial pulse and applies a downward traction on the pt’s arm being tested  Examiner then instructs pt to rotate the head to the opposite side and then extend the neck and look at the ceiling  A disappearance of the radial pulse indicates a positive test for thoracic outlet syndrome

15. Provocative Elevation (Roos) Test (thoracic outlet syndrome):  Examiner instructs pt to raise both hands overhead and rapidly pump the hands 15-30 times  Test is positive for vascular insufficiency indicating thoracic outlet syndrome if the pt experiences numbness, cramping, or tingling