Orthopedic Special Test Cluster for Shoulder Complex

Rotator cuff tear

• Source: Litaker et al., 2000

• 3 / 3 of the following

  • Age > 65

  • Weakness in external rotation (0 degree abduction and elbow 90 degree position)

  • Night pain

Rotator cuff full-thickness tear

• Source: Park et al., 2005

• 4 / 4 of the following

  • Age ≧ 60

  • Pain with infraspinatus external rotation test (0 degree abduction and elbow 90 degree position)

  • Positive drop arm test

  • Positive painful arc test

Anterior Instability (after a discrete injury)

• Source: Farber et al., 2006

• 2 / 2 of the following

  • Positive apprehension test

  • Positive relocation test

Posterior-inferior Instability

• Source: Kim et al., 2005

• 1 / 2 of the following

  • Positive Jerk test (More sensitive for posterior labral lesion)

  • Positive Kim’s test (More sensitive for inferior labral lesion)

SLAP (Superior Labrum from Anterior to Posterior) Lesions 1.

• Source: Schlechtier et al. 2009

• 2 / 2 of the following

  • Positive Passive Distraction test

  • Positive Active Compression Test of O’Brien

SLAP (Superior Labrum from Anterior to Posterior) Lesions 2.

• Source: Rosas et al. 2017

• 2/2 of the following

  • Positive Upper Cut test (pain or painful pop over the anterior shoulder)

  • Tenderness upon palpation of the biceps tendon in the bicipital groove

AC (Acromioclavicular) joint Pain cluster based on signs and symptoms

• Source: Cadogan et al. 2013

• 3/5 of the following can indicate AC joint symptoms. Less than 2/5 indicates that AC joint is not likely to be a pathology

  • Repetitive mechanism of pain onset – pay attention to the movements that can compress or shear the AC joint such as

    • Cross body adduction

    • Loaded pressing or overhead elevation

    • Carrying heavy load on the shoulder (I.e., backpack)

    • Lying directly on the shoulder

    • Behind back internal rotation

  • No pain below elbow

  • AC joint is thickened or swollen

  • No pain with passive glenohumeral abduction

  • No pain with passive external rotation at 90 degree abduction.

AC joint Provocation cluster

• Source: Chronopoulos et al. 2004; Krill et al. 2018

• AC joint area pain with both Cross Body Adduction test and AC Resisted Extension / AC shear Test / Paxino’s sign/test and

• Less pain with Active Compression Test of O’Brien in the first position (Internal rotation) – But be careful with the interpretation. This position is often said to give more stability to AC joint due to the joint position that give more compressive locking. But if the person has compression intolerance of this joint, it can be more provocative. 

Subacromial Pain Syndrome (SAPS) or Subacromial Impingement Syndrome (SAIS)

• Source: Michener et al. 2009

• 3/5 of the following

  • Hawkins-Kennedy test

  • Neer Test

  • Painful Arc Sign (painful arc 60 (45) ~120 degree)

  • Empty Can/Jobe Test

  • Pain or weakness in Resisted External rotation in with 0 degree abduction (Note: a positive result reflects the tendon’s response to load not mechanical compression.)

Internal Impingement Syndrome – No established cluster yet

• Mechanism – Rotator cuff contact against posteriorsuperior glenoid

• Source: Michener et al. 2004

• Deep posterior shoulder pain with posterior impingement sign test

Frozen shoulder – Consensus-based classification criteria

• Source: Kelley et al. 2013

  • Age 40 ~ 65

  • Gradual onset with progressively worsening pain and stiffness

  • Pain and stiffness that limit sleeping, grooming, dressing and reaching

  • Glenohumeral passive range of motion limited in several directions

  • External rotation as the most restricted direction, especially with the arm at the side

Frozen shoulder – General Diagnostic Criteria

• Source: Kelley et al. 2013

• One of the following for Glenohumeral passive external rotation range of motion (assess with fixated clavicle and scapula)

  • < 30 degree

  • Loss of greater than 50% compared to the other side

• And ≧ 25% reduction in PROM in at least 2 other planes of motion [I.E., commonly Abduction and flexion (assess with fixated clavicle and scapula)]

  
  

Adhesive Capsulitis – Orthopedic special testing (No established cluster yet)

• Source: Carbone et al. 2010

• Coracoid palpation provokes at least 3/10 higher pain compared to the palpation of

  • AC joint

  • Anterolateral subacromial area

• The rationale is that the coracoid sits directly over the rotator interval and coracohumeral ligament, which are the tissues thickened in adhesive capsulitis.

Ruling out Adhesive Capsulitis and/or arthritis through an Orthopedic special testing

• Source: Jia et al. 2008

• If the patient can abduct their shoulders to 90 degrees without a shrug, we can rule these conditions out due to the high sensitivity of this test.

• But this test is not used for ruling in these conditions.