Shoulder Impingement test & Ankle test in physiotherapy

Special tests of the shoulder joint:

Shoulder Impingement Test:

Following is the list of shoulder impingement test:

1. Neer test
2. Hawkins-Kennedy test
3. Posterior internal impingement test

1. Neer test: 

Aim of the test:
Identify impingement of supraspinatus tendon or long head of biceps
Patient position:
Patient silting & shoulder is passively internally rotated & fully abducted.
Positive sign:
Reproduce symptoms of pain within shoulder region

2. Hawkins-Kennedy test:

Aim of the test:
This shoulder impingement test Identify impingement of rotator cuff
Patient position:
Patient is sitting with arm flexed at 90° & elbow flexed to 90°, the examiner then stabilizes proximal to the elbow with their outside hand and with the other holds just proximal to the patient’s wrist. Then passively move the arm into internal rotation.
Positive sign:
Pain in the sub-acromial space.

3. Posterior internal impingement test:

Aim of the test:
Identifies an impingement between rotator cuff & greater tuberosity or posterior glenoid and labrum. 
Patient position:
Patient supine and move shoulder into 90° abduction, maximum external rotation, and 15°-20° horizontal adduction. 
Positive sign:
Reproduction of pain in posterior shoulder during test

shoulder-impingement
Shoulder Impingement test

Special tests of the shoulder joint in Physiotherapy:

1. Yergason’s test:


Aim of the test: 
Identifies the integrity of transverse ligament & bicipital tendonitis.
Patient position:
Patient is sitting with shoulder in neutral stabilized against trunk, elbow at 90°, & forearm pronated.

2. Speed’s test (Biceps straight arm)


Aim of test:
Identifies bicipital tendonitis
Patient position:
Patient sitting or standing with upper limb in full extension & forearm supinated. The therapist resists shoulder flexion. 


3. Drop arm test:


Aim of test:
Identifies tear &/or full rupture of rotator cuff
Patient position:
Patient sitting with shoulder passively abducted to 120°. The Patient is instructed to slowly bring arm down to side .Guard patient’s arm from falling in case it gives way.

4. Empty can test:

Aim of test:
Identifies tear &/or impingement of supraspinatus tendon or possible suprascapular nerve neuropathy.
Patient position:
Patient sitting with shoulder at 90° & no rotation. Resist shoulder abduction. Then place shoulder in “empty can” position, which is internal rotation and 30° forward (horizontal adduction), the patient’s thumb point down to the floor, and resist abduction. Differentiate if pain present between two positions. Another test with thumb up “full can” is best for maximum contraction of supraspinatus & resist abduction.
Positive sign:
Reproduces pain &/or weakness in supraspinatus tendon.

5. Lift-off test:


Aim of the test:
identify tear/weakness of subscapularis muscle & scapula instability.
Patient position:
Then the patient lifts his hand away from the back. If the patient is able to take the hand away from the back, the examiner should apply a load pushing the hand toward back to test the strength of the subscapularis and test how the scapula acts under dynamic loading.
Positive sign:
Inability to move the dorsum off the back indicates subscapularis rupture or dysfunction.

shoulder-impingement-Test
Shoulder Impingement Test

Special tests of the ankle & foot joint In Physiotherapy:

1. Anterior drawer test:


Aim of the test:
Identifies Ligament instability (particularly anterior talofibular ATF ligament). 
Patient position:
Patient is supine with heel just off edge of table in 20° plantar flexion. Stabilize lower leg and grasp foot. Pull foot (talus) anterior. 
Positive sign:
Positive finding if foot (talus) has excessive anterior glide and/ or pain is noted. 

2. Talar tilt (Kleiger):


Aim of the test:
Identifies Ligament instability (particularly calcaneofibular ligament) 
Patient position:
Patient side lying with knee slightly flexed and ankle in neutral. 
Positive sign:
Positive finding if excessive adduction or abduction occurs and/ or pain is noted.

3. Thompson test:

Aim of test:
Evaluate the integrity of the Achilles tendon.
Patient position:
Patient prone with foot off the edge of table. The examiner squeezes the calf muscles; normally there is planter flexion.

Shoulder Pain Relief Stretches

4. Homan’s test:


Aim of the test: 
Test for deep vein thrombosis (DVT) 
Patient position:
Patient supine or sitting with knee flexed, the examiner forcibly dorsiflex the patient’s ankle then palpate the calf muscle. 

5. Squeeze test:


Aim of the test: 
Identify integrity of the syndesmotic ligaments.
Patient position: 
Patient supine or sitting with knee flexed, the examiner places his hand 6 to 8 inches below the knee and squeezes the tibia and fibula together. 
Positive sign:
Positive test results in pain in the ankle, which indicates injury of the syndesmotic ligament and a possible high ankle sprain.

6. Feiss Line:

Aim of the test:
Identify the position of the navicular; the keystone of the medial longitudinal arch.
Patient position:
While the patient is NWB, mark inner apex of the medial malleolus and plantar aspect of 1st metatarsal phalangeal joint.


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