DESCRIPTIONS OF HOW TO CARRY OUT THE KEY TESTS USED TO
ASSESS THE SHOULDER JOINT IN ORTHOPAEDICS AND
TRAUMATOLOGY:
1. NEER'S TEST
• Purpose: To detect sub acromial impingement, particularly involving the rotator cuff
tendons (e.g., supraspinatus tendon) and the sub acromial bursa.
• How to Perform:
1. The patient should be seated or standing.
2. The examiner stands beside the patient, stabilizing the scapula with one
hand.
3. With the other hand, the examiner passively elevates the patient's straight
arm (in full pronation, i.e., thumb down) while maintaining the arm in
internal rotation.
4. The examiner moves the arm through a full range of forward flexion
(overhead) while stabilizing the scapula.
5. Positive result: If the patient experiences pain in the shoulder during the
manoeuvre, it suggests sub acromial impingement.
2. HAWKINS-KENNEDY TEST
• Purpose: To check for sub acromial impingement or rotator cuff tendinitis,
specifically involving the supraspinatus tendon.
• How to Perform:
1. The patient should be seated or standing.
2. The examiner flexes the patient’s shoulder to 90 degrees with the elbow bent
at 90 degrees.
3. The examiner stabilizes the arm and passively internally rotates the shoulder
by moving the forearm downward while holding the elbow steady.
4. Positive result: Pain during internal rotation indicates sub acromial
impingement, as the structures (tendons or bursa) are compressed under the
acromion.
3. EMPTY & FULL CAN TEST
• Purpose: To assess the integrity of the supraspinatus muscle and tendon, part of the
rotator cuff.
• How to Perform:
1. The patient is seated or standing, with both arms abducted to 90 degrees in
the scapular plane (30-45 degrees forward).
2. The patient’s arms are then fully internally rotated so that the thumbs point
downward (as if emptying a can).
3. The examiner applies downward pressure to both arms while the patient
attempts to resist (maintain the arm position).
4. Positive result: Weakness or pain in the affected arm suggests a
supraspinatus tendon injury or tear.
4. APPREHENSION TEST (ANTERIOR APPREHENSION)
• Purpose: To evaluate shoulder instability, specifically anterior instability or
dislocation of the glenohumeral joint.
• How to Perform:
1. The patient is either seated or lying supine.
2. The examiner abducts the patient’s arm to 90 degrees and externally rotates
the shoulder while applying slight forward pressure on the posterior aspect
of the humeral head.
3. Positive result: The patient exhibits apprehension (fear of shoulder
dislocation) or resists further external rotation, indicating anterior shoulder
instability.
5. O'BRIEN'S TEST (ACTIVE COMPRESSION TEST)
• Purpose: To assess for a superior labral tear from anterior to posterior (SLAP lesion)
or acromioclavicular (AC) joint pathology.
• How to Perform:
1. The patient stands with their arm flexed to 90 degrees and the elbow fully
extended.
2. The arm is then adducted 10-15 degrees and internally rotated, so the thumb
points down.
3. The examiner applies downward force on the arm while the patient resists.
4. The test is then repeated with the arm externally rotated (palm up).
5. Positive result: Pain during the first maneuver (with internal rotation) that
decreases during the second maneuver (with external rotation) suggests a
SLAP lesion. Pain localized at the AC joint may indicate AC joint pathology.
6. LIFT-OFF TEST (GERBER'S TEST)
• Purpose: To evaluate subscapularis muscle strength, part of the rotator cuff.
• How to Perform:
1. The patient is seated or standing and places the back of their hand against
the lower back (internal rotation).
2. The patient is asked to lift their hand away from the back without
straightening the elbow.
3. The examiner can apply gentle resistance to this motion.
4. Positive result: Inability to lift the hand off the back or weakness indicates
subscapularis tendon pathology or tear.
7. SPEED'S TEST
• Purpose: To assess biceps tendon pathology (e.g., tendinitis or SLAP lesion).
• How to Perform:
1. The patient is seated or standing with their elbow extended and forearm
supinated.
2. The examiner resists forward flexion of the patient’s arm at the shoulder,
applying downward pressure while the patient tries to lift the arm.
3. Positive result: Pain in the bicipital groove during resisted flexion indicates
biceps tendon pathology.
8. YERGASON'S TEST
• Purpose: To test for biceps tendinopathy or instability of the biceps tendon in the
bicipital groove.
• How to Perform:
1. The patient flexes the elbow to 90 degrees, and the forearm is in a pronated
position.
2. The examiner stabilizes the elbow and resists as the patient attempts to
supinate the forearm and externally rotate the arm.
3. Positive result: Pain in the bicipital groove or a palpable snapping sensation
indicates biceps tendon instability or tendinitis.
