Table 2. Provocative Tests for Shoulder Evaluation via Telephone or Video Visits.

Note: Tests such as the posterior apprehension test, sulcus sign test, labrum grind test, clunk test, or relocation test (which explore for shoulder instability and labrum tears); as well as maneuvers for cervical spine pathology, should only be done by an experienced physician during in-person visits. These tests are not recommended to be carried out over video or telephone consultations.

*Figure 2B; **Figure 2C; ¤Figure 3A; ¤¤Figure 3B; ¤¤¤Figure 3C

These classical tests may be modified by asking the patient to carry objects of known weight (such as a light dumbbell, water bottle, a bean can, pasta sauce bottle, etc.) in lieu of examiners active resistance to movements. Glass containers should be avoided for they are prone to causing accidents if dropped.
Apley Scratch Test “With the affected arm, going behind your head, attempt to touch your back over the scapula of the opposite side (abduction & external rotation). Now try to touch the same spot with the same hand but going behind your lower back instead (internal rotation and adduction). Repeat the same movements with the opposite arm to compare.”	Loss of range of motion could represent a rotator cuff pathology.
Speed’s Test (modified) “With the affected arm outstretched in front with a 15° bend in the elbow, place hands palms-up (supination) while holding a weighted object and slowly raise the as far up as possible starting from waist level” Alternatively, the patient may push down on affected hand with other side and try to resist this movement.* Sensitivity: 32% [23] Specificity: 61% [23]	Pain in the anterior shoulder (site of the long head of biceps tendon insertion) is considered a positive test and may indicate a lesion in the biceps tendon or labrum pathology.
Yergason’s Test (modified) “Place the affected arm against the side of your thorax, then bend your elbow 90° and turn the hands palms-down (pronation). With the unaffected handhold the affected hand, and while keeping arm tight against thorax, resist the following three movements: twisting the forearm towards palms up (supination), flexion of the forearm over the arm, and swinging forearm outward (external rotation of humerus).” Sensitivity: 43% [24] Specificity: 79% [24]	Pain at the superior glenohumeral joint suggests a superior labrum anterior-posterior (SLAP) lesion or pathology in the long head of biceps tendon [18]. Note: normally, the examiner palpates the bicipital groove for a snap which would suggest a tear or laxity of the transverse humeral ligament, but unfortunately this cannot be explored by the patient while performing this modified test.
Empty Can (Job’s) Test (modified) “Grab a weighted object with the hand of the affected side, stretch arm out in front of you with 30° of flexion in your elbow, and twist your forearm until thumb is pointed down (internal rotation), and hold this position for 3 seconds if possible.” ** Sensitivity: 52.6% [22] Specificity: 82.4% [22]	The test is considered positive if weakness or pain is experienced in the shoulder by the patient, and it suggests a lesion in the supraspinatus tendon, rotator cuff impingement, or neuropathy of the suprascapular nerve [18,25].
Full Can (Neer) Test (modified) This test is very similar to the Empty Can test, except for the thumb is now pointing up toward the roof (instead of down toward the floor). Sensitivity: 79% [23] Specificity: 53% [23]	(same as above)
Hawkins-Kennedy Test (modified) “Grab a weighted object with the hand of the affected side, flex shoulder to 90° and flexes the elbow 90° so that forearm is in front of you horizontally. From this position, slowly swing forearm down towards the floor (internal rotation).” Sensitivity: 79% [23] Specificity: 59% [23]	This test is considered positive if the patient experiences shoulder pain during the maneuver, and it may suggest subacromial impingement or rotator cuff tendinopathy [18,25].
Crossover (Scarf) Test (modified) “Place arm of affected shoulder straight out in front of you (shoulder flexed at 90°). With opposite hand, grab the elbow of the affected side and pull the affected arm towards your chest horizontally (as if you were placing a scarf around your neck) until full range of motion.” ¤ Sensitivity: 77% [20] Specificity: 79% [20]	This test is considered positive if the patient experiences shoulder pain during the maneuver, and it may suggest pectoralis major or subscapularis tendon tear, acromioclavicular joint pathology, posterior labral tear, clavicle or proximal humerus fracture [18,25].
O’Brien Test (modified) This maneuver will have two parts to it. “Grab a weighted object in each hand, straighten your arms in front of you (90⁰ of shoulder flexion), and bring your hands close together – about 3 inches apart (10º-20º horizontal adduction). From this position, twist your forearms inward until thumbs point down towards the floor (full pronation) and hold this position for three seconds.” “Afterwards, from the previous position, twist your forearms outward until palms are facing up towards ceiling (full supination) and hold this position for 3 seconds.” (Sensitivity and specificity reports vary widely in literature)	This test is considered positive if the pain is elicited during the first maneuver (thumbs facing down) and reduced/eliminated during the second maneuver (palms facing up). It suggests labral pathology. If pain is experienced with both maneuvers, it suggests AC joint pathology.
Apprehension Test (modified) “If possible, lay down flat on your back on a couch or bed, with the arm of the affected side on the edge. Grab a weighted object with the hand of the affected side, and slowly flex your shoulder at 90º and elbow at 90º as if you were going to throw a baseball. Try to reach the end of the range of motion.” ¤¤ (however it is best to perform in supine position) Sensitivity: 53% [22] Specificity: 99% [22]	The test is considered positive if the patient feels apprehension (feeling of instability or that shoulder is going to “pop-out” or dislocate), and this would suggest instability of the glenohumeral joint in an anterior direction. If the patient feels pain with this maneuver instead of apprehension, a different pathology (such as rotator cuff impingement or glenohumeral arthritis) may be present [18,25].
The cervical spine should be assessed as a possible etiology for shoulder pain. Ask the patient to palpate his/her cervical spine for areas of tenderness. Also assess flexion, extension, lateral rotation and bend by asking the patient: “Look up, down, and to the sides. Bend your neck so that your left/right ear touches your left/right shoulder respectively. Place the palm of the hand of your affected side on top of your head, does this relieve the pain? (Shoulder Abduction Relief Sign Test).” ¤¤¤ Note: virtual evaluation of cervical spine is limited. If cervical spine pathology is suspected, the patient should be advised to schedule an in-person.	Cervical spine pathology (such as radiculopathy, arthritis, sprain/strain, or fracture) may be the source of shoulder pain if the patient experiences pain or limitation with flexion, extension, twisting, or side bending; or tenderness on spinous processes or paraspinal muscles [16]. Relief of pain during shoulder abduction relief sign test suggests cervical radiculopathy, especially when lower cervical roots are involved.