Table 3.
Special Testing of the Shoulder via Telemedicine
| Test (Clinical Correlate) | Assistance Required? | How to Examine via Telemedicine |
|---|---|---|
| Jobe/Empty can test (supraspinatus injury) | No* | Patient is asked to hold a weighted object, such as a large soda bottle, with their arms in 90º abduction and 40º of forward flexion with the thumbs pointing down (pronation). Alternatively, a caregiver can provide resistance. Pain or weakness with resistance is a positive test. |
| Gerber/Lift-off test (subscapularis injury) | No* | With their back facing the camera, patients are asked to place the dorsum of their hand on their lower back in internal rotation and lift their hand away. If the patient is able to do the latter, a caregiver can provide resistance against extension of the arm as it lifts off the back. Pain and weakness are a positive test. |
| Hornblower test (teres minor injury) | Yes | Patient places their arm in 90º in the scapular plane and flexes the elbow to 90º. Caregiver provides resistance against the patient’s external rotation. Pain or weakness is a positive test. |
| Resisted external rotation (infraspinatus and teres minor injury) | No* | Patient lies on unaffected side facing the camera so that the injured shoulder faces up. With that elbow flexed at 90º and tucked to the side, patient lifts a weighted object in external rotation. Alternatively, patient sits with arms close to their side and elbow flexed at 90º and caregiver resists patient’s external rotation. Pain or weakness is a positive test. |
| Drop arm sign (complete RC tear) | No* | Patient is asked to abduct their arm to 90º with the palm down, then lower that arm slowly. The arm dropping to the side is a positive test. Alternatively, a caregiver can be asked to passively abduct the patient’s arm and let it go. |
| Neer’s sign (subacromial impingement) | No* | Patient is asked to hold a weighted object and perform maximal forward flexion and internal rotation of their shoulder. Alternatively, a caregiver can passively put the patient’s arm in forward flexion and internal rotation. Pain reproduction is a positive test. |
| Hawkins-Kennedy test (subacromial impingement) | No* | Ask patient to abduct the shoulder and flex the elbow, both to 90º and use the other hand to grasp the wrist. While keeping the elbow in the same bent position, ask patient to push their wrist down, while internally rotating the shoulder.18,47,48 Repeat several times. Pain is a positive test. Patient can also touch the top of their nonaffected shoulder with the hand of affected side while lifting that elbow.76 Alternatively, a caregiver can perform the original test with guidance. |
| Painful arc (subacromial impingement) | No | Patient is instructed to abduct the arm in the scapular plane and communicate when they feel pain. A positive test is pain between 60–120º which reduces past 120º. |
| O’Brien test (AC joint pathology, glenoid labrum injury) | No* | Patient forward flexes shoulder to 90º with full elbow extension, combined with 10–15º of horizontal adduction and internal rotation. Self-resistance or caregiver resistance can be applied with a downward force to the tested arm. The maneuver is repeated will full forearm supination. A weighted object can also be used.20,47,48 |
| Apley scarf (crossover) test (AC joint pathology) | No* | Patient places their arm in 90º forward flexion and can use their other arm to adduct the injured arm across their chest. Pain at AC joint with or without limitation of movement is a positive test. Alternatively, a caregiver can passively perform the adduction. |
| Speed test (bicipital tendonitis) | No* | While holding a weighted object, patient forward flexes their shoulder to 60º with the elbow in extension and forearm in supination. Pain in the bicipital groove is a positive test. Alternatively, the patient can use resistance provided by pushing upwards on a table/desk or apply self-resistance with the opposite arm.18 A caregiver can also resist the patient’s flexion while palpating the bicipital groove. |
| Yergason test (bicipital tendonitis) | No* | With the arm to the side and elbow flexed at 90º, patients are to provide self-resistance against supination and external rotation. Alternatively, a caregiver can resist supination and external rotation. Pain or weakness in the bicipital groove is a positive test. |
| Load-shift test (glenohumeral joint instability) | Yes | Patient sits with arms relaxed at sides while caregiver moves humeral head anteriorly and posteriorly. Substantial movement is a positive test. |
| Anterior apprehension (anterior shoulder instability) | No* | Patient performs 90º of shoulder abduction combined with 90º of external rotation. Apprehension with the sensation of subluxation of the humeral head is a positive test, not pain. Patient can also place their elbow against a vertical surface and slightly lean forward.76 Alternatively, the patient can lie supine in the same position with the arm hanging off the bed while the caregiver slowly provides an external rotation force. |
| Sulcus sign (inferior shoulder instability) | Yes | Patient sits with the arm to the side and caregiver pulls elbow downward. A gap > 1 finger-width between lateral acromion and humeral head suggests inferior instability. |
| Roos test (thoracic outlet syndrome) | No | Instruct patient to place shoulders in 90º abduction- external rotation and then open and close fists slowly for 3 minutes. Pain in the neck, shoulder, arm with paresthesia in forearm and fingers is a positive test. |
Note: *Test can be facilitated by a caregiver.
Abbreviations: RC, rotator cuff; AC, acromioclavicular.