Table 1 Clinical tests of the shoulder for the clinical examination

O’Brien’s test

The arm is forward-flexed to 90° with the elbow in full extension and is then adducted 10° to 15° medial to the sagittal plane of the body. The forearm is then pronated, and the arm is internally rotated so that the thumb points downward. The physician applies a downward force to the arm and, while maintaining the overall position of the arm, supinates the arm and repeats the maneuver.

  O’Brien et al. [6]

The test is positive if the patient experiences pain during the first maneuver and the pain decreases or disappears with the second.

Jobe’s test

The patient places both arms in 90° abduction and 30° horizontal adduction, in the plane of the scapula, with his thumbs pointing downward in order to produce medial rotation of the shoulder; the examiner then pushes the patient’s arms downward while asking the patient to resist the pressure. Inability to resist despite pain denotes tendonitis.

  Jobe and Jobe [7]

Hawkins-Kennedy test

The patient raises the arm forward to 90°, while the examiner forcibly internally rotates the shoulder. Pain with this maneuver suggests subacromial impingement or rotator cuff tendonitis.

  Hawkins and Kennedy [8]

Palm-up test

The patient is asked to elevate the arm anteriorly against resistance, with the elbow extended and the palm facing upward. The test is positive if the patient feels pain at the anterior aspect of the arm along the course of the long head of the biceps brachii.

  Gilcreest [9]

Compression-rotation test

The shoulder is placed at 45° of abduction. The clinician stabilizes the superior portion of the shoulder with one hand and grasps the elbow in the other. The distal hand applies a compressive force up the long axis of the humerus toward the superior labrum. While compressing the humerus cranially, a concurrently produced clockwise and counterclockwise circumduction is performed in an attempt to entrap a piece of labrum between the humeral head and the glenoid fossa. The patient’s complaint of pain, snapping, or catching sensations is considered a positive test for a superior labral tear or ‘superior labrum anterior to posterior’ (SLAP).

  Snyder et al. [10]

Apprehension-relocation test

With the patient lying supine on the examination table, the clinician stands along the patient’s affected side and abducts the patient’s arm to 90°, flexes the elbow to 90°, and externally rotates the shoulder slowly. A positive test is indicated by a look or feeling of apprehension or alarm on the patient’s face and the patient’s resistance to further motion at the glenohumeral joint; application of a posteriorly directed force to the humeral head will remove the patient’s anxiety.

  Rowe and Zarins [11]

Across body test

The arm is brought to 90° of forward flexion and then passively brought across the front of the body. The test is positive if pain is elicited at the anterior shoulder, indicating a possible subcoracoid bursitis or labral/capsular tear.

  Sillman and Hawkins [12]

Gerber’s lift-off test

The patient is asked to place one hand against the back at the level of the waist with the elbow in 90° flexion. The examiner pulls the hand to about 5 to 10 cm from the back while maintaining the 90° bend in the elbow.

  Gerber and Krushell [13]

The patient is then asked to hold the position without the examiner’s help.

This test is positive if the hand cannot be lifted off the back, detecting complete rupture of the subscapularis tendon.

Sulcus sign

With the patient’s arm positioned at 0° of abduction, the clinician grasps the patient’s relaxed arm just distal to the elbow on the dorsal surface of the forearm and applies a gentle, inferiorly directed force, parallel to the long axis of the humerus. In patients with increased glenohumeral laxity, a sulcus sign will appear just inferior to the acromion.

  Neer and Foster [14]