Regional and Spinal Orthopedics (pg # out of 6th Ed. Magee) Jessica MacCarron
Region of Orthopedic Tests: Shoulder:
Name(s) Apprehension (Crank) Test Page 301
Starting Position Exam. abd. GH to 90 and ER slowly. Must be done slowly. Should be done BL wirh ROM compared
Testing Directions
Type of Tissue Tested Traumatic instability of GH
Outcomes + for posterior internal impingement if posterior pain increases (if + repeat test in 110-120 abd.)
+ for instability if pt feels apprehensive or resists further motion or mm spasm or it feels like it will dislocate again. (All of
these are >pain)
Other Notes This test takes the jt in close packed position ( translation)
Falcrum test is similar
Name(s) Rockwood Test for Anterior Instability (modification of crank test) Page 307
Starting Position Exam. behind seated pt.
Testing Directions With arm at side, exam. does ER of GH. Then abd to 45 and PROM of ER repeated. Do at 90 and 120 abd also.
*Be sure to palpate jt/tissue while testing
Type of Tissue Tested Anterior GH stablizers
Outcomes + for ant instability if marked apprehension with posterior pain with arm at 90, uneasiness and some pain at 45 and 120
and no apprehension at 0
Other Notes Rowe and fulcrum tests also stress anterior GH structures (together called augmentation tests)
Name(s) Push-Pull Test for Posterior Instability Page 313
Starting Position Pt supine
Testing Directions Exam. holds pt arm at wrist, abd arm 90 and forward flex to 30
Exam. puts other hand on humerus, close to humeral head. RMT pulls up on arm near wrist and down on arm near
humerus
Type of Tissue Tested Posterior GH stabilizers
Outcomes Norm: 50% posterior translation
+: >50% posterior translation OR pt is apprehensive or has pain
Other Notes Pull THEN push (need to create a gap before pushing)
Name(s) Feagin Test (“second half of sulcus sign”) Page 313
Starting Position Pt standing with arm abd 90 with their arm rested on the exams GH and extends pt elbow. Arm is in neutral rotation.
Exam. holds upper and middle 1/3 of humerus with clasped hands
Testing Directions Exam. pushes humerus and towards the exam. (“scooping motion”)
Type of Tissue Tested Inferior GH capsule instability
Outcomes + for inferior capsule laxity if a sulcus is seen above coracoid process or pt apprehension
Other Notes Can be done sitting (hold arm at elbow) or standing (push down on GH)
Name(s) Rowe Test for Multidirectional Instability Page 314
Starting Position Pt stands and forward flexes 45 at waist with arms relaxed, towards floor
Exam’s index and middle fingers sit on ant humeral head and thumb over post (exam. pulls arm down sl. towards the floor)
Testing Directions #1 Test inferior instability: traction and sulcus sign is evident (just traction, no other pushing)
#2 Test ant instab: Humeral head pushed ant with thumb and arm ext 20-30 from verticle position, still applying traction
#3 Test post instab: Humeral head pushed post with fingers and arm flexed 20-30, still applying traction
Type of Tissue Tested Ant, post, inf GH instability (mm)
Outcomes Ant/post/inf instability
Other Notes Use inside arm for traction to make it easier
Name(s) Test for Inferior Shoulder Instability (Sulcus Sign) Page 314
Starting Position Pt stands with arm by side and GH mms relaxed
Testing Directions Exam. grasps pt forearm below elbow and pulls distally
Should be tested in >1 position (commonly 20 and 50 abd and the position of pt discomfort)
Type of Tissue Tested Inferior GH instability
Outcomes Sulcus sign presence may mean there is inferior instability or GH laxity (only if pt is symptomatic)
Other Notes Sulcus sign with a subluxation feeling is also significant
Sulcus sign grading: <I cm: +1. 1-2 cm: +2. >2 cm: +3
Region of Orthopedic Tests: Shoulder:
Name(s) Apprehension (Crank) Test Page 301
Starting Position Exam. abd. GH to 90 and ER slowly. Must be done slowly. Should be done BL wirh ROM compared
Testing Directions
Type of Tissue Tested Traumatic instability of GH
Outcomes + for posterior internal impingement if posterior pain increases (if + repeat test in 110-120 abd.)
+ for instability if pt feels apprehensive or resists further motion or mm spasm or it feels like it will dislocate again. (All of
these are >pain)
Other Notes This test takes the jt in close packed position ( translation)
Falcrum test is similar
Name(s) Rockwood Test for Anterior Instability (modification of crank test) Page 307
Starting Position Exam. behind seated pt.
Testing Directions With arm at side, exam. does ER of GH. Then abd to 45 and PROM of ER repeated. Do at 90 and 120 abd also.
*Be sure to palpate jt/tissue while testing
Type of Tissue Tested Anterior GH stablizers
Outcomes + for ant instability if marked apprehension with posterior pain with arm at 90, uneasiness and some pain at 45 and 120
and no apprehension at 0
Other Notes Rowe and fulcrum tests also stress anterior GH structures (together called augmentation tests)
Name(s) Push-Pull Test for Posterior Instability Page 313
Starting Position Pt supine
Testing Directions Exam. holds pt arm at wrist, abd arm 90 and forward flex to 30
Exam. puts other hand on humerus, close to humeral head. RMT pulls up on arm near wrist and down on arm near
humerus
Type of Tissue Tested Posterior GH stabilizers
Outcomes Norm: 50% posterior translation
+: >50% posterior translation OR pt is apprehensive or has pain
Other Notes Pull THEN push (need to create a gap before pushing)
Name(s) Feagin Test (“second half of sulcus sign”) Page 313
Starting Position Pt standing with arm abd 90 with their arm rested on the exams GH and extends pt elbow. Arm is in neutral rotation.
Exam. holds upper and middle 1/3 of humerus with clasped hands
Testing Directions Exam. pushes humerus and towards the exam. (“scooping motion”)
Type of Tissue Tested Inferior GH capsule instability
Outcomes + for inferior capsule laxity if a sulcus is seen above coracoid process or pt apprehension
Other Notes Can be done sitting (hold arm at elbow) or standing (push down on GH)
Name(s) Rowe Test for Multidirectional Instability Page 314
Starting Position Pt stands and forward flexes 45 at waist with arms relaxed, towards floor
Exam’s index and middle fingers sit on ant humeral head and thumb over post (exam. pulls arm down sl. towards the floor)
Testing Directions #1 Test inferior instability: traction and sulcus sign is evident (just traction, no other pushing)
#2 Test ant instab: Humeral head pushed ant with thumb and arm ext 20-30 from verticle position, still applying traction
#3 Test post instab: Humeral head pushed post with fingers and arm flexed 20-30, still applying traction
Type of Tissue Tested Ant, post, inf GH instability (mm)
Outcomes Ant/post/inf instability
Other Notes Use inside arm for traction to make it easier
Name(s) Test for Inferior Shoulder Instability (Sulcus Sign) Page 314
Starting Position Pt stands with arm by side and GH mms relaxed
Testing Directions Exam. grasps pt forearm below elbow and pulls distally
Should be tested in >1 position (commonly 20 and 50 abd and the position of pt discomfort)
Type of Tissue Tested Inferior GH instability
Outcomes Sulcus sign presence may mean there is inferior instability or GH laxity (only if pt is symptomatic)
Other Notes Sulcus sign with a subluxation feeling is also significant
Sulcus sign grading: <I cm: +1. 1-2 cm: +2. >2 cm: +3
