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and Teres Minor –
Posterior View
RC Testing - Subscapularis
Anatomy: Connects scapula to 
humerus, w/origin on anterior 
surface of scapula. 
FiringÆinternal rotation. 
Function can be tested using 
"Gerber's lift off test:" 
1. Patient places hand behind 
back, palm facing out. 
2. Pt lifts hand away from back. 
3. If tendon partially torn, 
movement limited or causes 
pain. Complete tears 
prevents any movement in 
this direction
Sucscapularis – Anterior View
Impingement, Rotator Cuff Tendonitis and 
Sub-Acromial Bursitis
• 4 tendons of RC pass 
underneath acromion/coraco-
acromion ligamentÆ insertions 
on humerus. 
• Space between 
acromion/coracoacromial lig & 
tendons can become narrowed 
• Causes tendons (in particular, 
supraspinatus) to become 
"impinged upon.Ӯresulting 
friction inflames tendons & 
subacromial bursa (between 
tendons & acromion). 
• Net result =s shoulder pain, 
particularly raising arm over 
head (e.g. swimming, reaching 
up on a top shelf, arm 
positioning during sleep).
Anatomy - Impingement 
and Bursitis
Neer’s Test For Impingement 
1. Place 1 hand on 
patient's scapula, & 
grasp forearm 
w/other. Arm 
internally rotated 
(thumb pointed 
2. Foreward flex arm, 
positioning hand 
over the head. 
3. PainÆ
impingement. Shoulder Anatomy Fig 5 - AAFP 
Evaluation Painful Shoulder
Hawkin’s Test For Impingement 
and Subacromial Palpation
Hawkin’s Test:
1. Raise patient's arm to 90 
degrees forward flexion. 
2. Rotate internally (i.e. thumb 
pointed down)Æplaces greater 
tubercle humerus in position to 
further compromise space 
beneath acromion. 
3. PainÆ impingement. 
Subacromial Palpation:
1. Identify acromion by following 
scapular spine laterally to tip
2. Palpate in region sub-acromial 
spaceÆ pain if tendons/bursa 
Subacromial Palpation
Shoulder Anatomy Fig 5 -
AAFP Evaluation Painful 
Biceps Tendon – Anatomy and Function
• Long head biceps tendon 
runs in bicipital groove 
humerus, inserting @ top 
of glenoid.
• Subject to same 
forces/stresses as 
tendons of RC.
• Biceps flexes & 
supinates forearm; also 
helps flex.
• Inflammation 
(tendonitis)Æpain @ top 
& anterior shoulder 
areas, particularly 
w/flexion or supination.
Anatomy – Biceps Tendon
Biceps Tendon Testing and 
1. Palpate biceps tendon bicipital 
groove. PainÆtendonitis.
2. Confirm you’re on tendonÆ
patient supinates while you 
Resisted Supination (Yergason’s 
1. Elbow flexed 90 degrees, 
shoulder adducted (ie elbow 
bent @ right angle, arm against 
2. Grasp patient's hand, direct 
them to rotate arm such that 
hand is palm up (supinate) 
while you resist. 
3. PainÆtendonitis
Palpation Yergason’s
“Popeye Muscle”ÆBicep’s Rupture
Popeye The Sailor
Acromio-Clavicular Joint Pathology
• A-C joint minimally mobile. 
Inflammation & 
degenerationÆ shoulder 
Specifics of Testing: 
1. Palpate point @ which end 
of clavicle articulates 
2. Push on areaÆ ? pain
3. Ask patient to move arm 
across chestÆstresses A-C 
jointÆ pain in setting of 
4. A-C joint separationÆ
swelling & pain on cross arm 
testing or palpation
Palpation of A-C Joint
A-C Joint Testing - Fig 7 - AAFP 
Evaluation Painful Shoulder
Anatomy – A-C Joint Pathology
□ Observation, palpation General orientation
□ Range of motion (flexion/extension, abduction/adduction, 
internal/external rotation), with palpation
Decreased with variety shoulder pathology, crepitus on 
palpation with DJD
□“Empty can test” (arm abducted 60 degrees, forward 
flexed ~ 30 degrees, thumb down, resistance to additional 
Pain/weakness suggests Supraspinatus tear
□ Resisted external rotation Pain/weakness suggests Infraspinatus or Teres Minor tear
□ Resisted internal rotation and lift off from back (Gerber’s 
Pain/weakness suggests Subscapularis tear
□ Sub-acromial palpation Pain suggests bursitis/impingement
□ Hawkin’s test (elbow 90 degrees, arm forward flexed 90 
degrees, examiner internally rotates)
Pain suggests bursitis/impingement
□ Neer’s test (thumb down, elbow straight, examiner raises 
arm thru forward flexion)
Pain suggests bursitis/impingement
□ Long head biceps palpation Pain suggests biceps tendonitis
□Yergason’s (elbow 90 degrees, arm adducted, patient 
attempts supination while examiner resists)
Pain suggests biceps tendonitis
□A-C joint tenderness, Cross arm test (reach across 
towards opposite shoulder)
Pain suggests a-c joint pathology (djd, dislocation)
Maneuver Clinical Interpretation
Summary of Maneuvers – Shoulder Exam
	Musculoskeletal Examination: General Principles and Detailed Evaluation Of the Knee & Shoulder
	General Principles
	Historical Clues
	Examination Keys To Evaluating Any Joint
	Terminology: Flexion/Extension, Abduction/Adduction
	Knee Anatomy:�Observation & Identification of Landmarks
	Observation (cont)
	Range of Motion (ROM)
	Assessment For A Large Effusion - Ballotment 
	Menisci – Normal Function and Anatomy
	Evaluating for Meniscal Injury – Joint Line Palpation
	Additional Tests For Meniscal Injury McMurray’s Test – Medial Meniscus
	McMurray’s Test – Lateral Meniscus
	Additional Assessment For Meniscal Injury – Appley Grind Test
	Ligaments – Normal Anatomy and Function
	Specifics of Testing – Medial Collateral Ligament (MCL)
	Lateral Collateral Ligament (LCL)
	Another Method For Assessing The LCL and MCL
	Anterior Cruciate Ligament (ACL) – Lachman’s Test
	Drop Lachman’s Test�For Patient’s With Big Legs &/or Examiners With Small Hands
	Posterior Cruciate Ligament (PCL) – Posterior Drawer Test
	Anterior Knee Pain: Assessment for Patellofemoral Problems and Chondromalacia
	Slide Number 23
	The Shoulder Exam�Overview of Anatomy
	Anatomy – Anterior View
	Observation & Palpation
	Active Range Of Motion�Flexion/Extention and Abduction/Adduction
	ROM Cont – Internal/External Rotation
	Passive ROM
	The Rotator Cuff
	RC Testing – Supraspinatus�(“empty can test”
	RC Testing – Infraspinatus and Teres Minor
	RC Testing - Subscapularis
	Impingement, Rotator Cuff Tendonitis and Sub-Acromial Bursitis
	Neer’s Test For Impingement 
	Hawkin’s Test For Impingement and Subacromial Palpation
	Biceps Tendon – Anatomy and Function
	Biceps Tendon Testing and Pathology
	Acromio-Clavicular Joint Pathology
	Slide Number 40

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