The shoulder is one of the most complex joints in the body, involving the glenohumeral, acromioclavicular, and sternoclavicular joints. This guide covers the major orthopedic special tests used to assess shoulder pathology, organized by the structure or condition being tested.

Impingement

These tests screen for subacromial impingement — compression of the rotator cuff tendons and subacromial bursa under the coracoacromial arch.

• Neer Impingement Test — Passive internal rotation with the arm in forward flexion; pain reproduced as the supraspinatus is compressed against the anterior acromion.
• Hawkins-Kennedy Test — Passive internal rotation at 90° forward flexion; ~92% sensitive for subacromial impingement. One of the most commonly used shoulder screening tests.
• Painful Arc Test — Pain between 60–120° of active shoulder abduction suggests supraspinatus tendon or subacromial bursa involvement.
• Yocum’s Test — The patient places their hand on the opposite shoulder and actively raises the elbow; pain reproduced indicates subacromial impingement.
• Cross-Over Impingement Test — Passive horizontal adduction compresses the subacromial space and AC joint; can indicate subacromial impingement or AC joint pathology depending on pain location.

Rotator Cuff Integrity

These tests assess specific rotator cuff muscles for tears or weakness. The supraspinatus, subscapularis, and teres minor each have dedicated tests.

• Empty Can Test — Resisted shoulder flexion at 90° and 30° abduction with the thumb pointing down. Pain or weakness suggests supraspinatus pathology.
• Full Can Test — The same position as the Empty Can but with the thumb pointing up (forearm supinated). An alternative supraspinatus test that may produce less subacromial impingement than the empty can position.
• Drop Arm Test — The patient slowly lowers the arm from 90° abduction. Inability to perform a controlled lowering suggests a significant rotator cuff tear.
• Bear Hug Test — The patient holds their hand on the opposite shoulder with the elbow forward; the examiner attempts to lift the hand away. Weakness or inability to resist indicates subscapularis pathology.
• Gerber’s Lift-Off Test — The patient places the dorsum of their hand on their lower back and lifts it away from the body. Inability to perform this movement indicates subscapularis tear.
• Hornblower’s Test — The patient attempts to externally rotate with the arm at 90° abduction. Inability to externally rotate from this position indicates teres minor pathology.
• French Horn Test — The patient holds the arm in a position mimicking a French horn player; weakness with resisted external rotation from this position indicates posterior rotator cuff involvement.

Biceps Tendon

These tests load the long head of the biceps tendon and its attachment at the superior glenoid labrum.

• Speed’s Test — Resisted shoulder flexion with the elbow extended and forearm supinated. Pain in the bicipital groove suggests long head of biceps tendinopathy or SLAP lesion.
• Yergason’s Test — Resisted supination and external rotation with the elbow at 90° flexion. Pain in the bicipital groove indicates biceps tendon pathology or instability within the groove.
• Ludington’s Sign — The patient clasps both hands behind the head while the examiner palpates the bicipital groove bilaterally. Absence of biceps tension on one side indicates a ruptured long head of biceps.

Acromioclavicular (AC) Joint

• Scarf Test (Cross Arm Adduction Test) — Passive horizontal adduction to end range compresses the AC joint; pain at the top of the shoulder indicates AC joint pathology.
• AC Joint Distraction Test — Traction applied to the arm distracts the AC joint; reproduction of AC joint pain indicates pathology.
• AC Shear Test — The examiner places hands on the anterior and posterior shoulder and compresses; pain or movement at the AC joint indicates pathology.
• Piano Key Sign — Visible superior displacement of the distal clavicle that springs back when depressed, indicating AC joint disruption or type II/III separation.

SLAP Lesions & Labrum

These tests screen for superior labral tears (SLAP lesions) and other labral pathology. No single test is definitive — accuracy improves when tests are used in combination.

• O’Brien’s Test (Active Compression Test) — Resisted downward force at 90° forward flexion comparing full internal rotation to external rotation. Pain or click in IR that diminishes in ER suggests SLAP lesion; pain at the AC joint suggests AC joint pathology.
• Anterior Slide Test (Kibler Test) — The patient places hands on hips; the examiner applies an anterior and slightly superior force to the elbow. Pain or a pop at the front of the shoulder indicates SLAP lesion.
• Biceps Load Test — With the shoulder in 90° abduction and maximum external rotation (apprehension position), the examiner asks the patient to flex the elbow against resistance. Increased apprehension or pain suggests a SLAP lesion contributing to instability.
• Clunk Test — With the arm in full abduction, the examiner applies axial compression and rotation. A clunk or grinding sensation indicates a labral tear.
• Grind Test — Axial compression combined with rotation applied through the humerus; pain or grinding indicates glenoid labral pathology.

Anterior Instability

These tests reproduce anterior glenohumeral instability. The Apprehension and Jobe Relocation tests are typically used together — a positive Apprehension confirmed by Relocation is highly specific for anterior instability.

• Apprehension Test — With the arm at 90° abduction, the examiner gradually externally rotates the shoulder. Patient apprehension (not just pain) indicates anterior instability.
• Jobe Relocation Test — Performed immediately after a positive Apprehension Test. Posterior pressure on the humeral head relieves apprehension, confirming anterior instability rather than impingement as the cause.
• Crank Test — Axial compression combined with rotation with the arm at approximately 160° of elevation. Pain or a click suggests an anterior labral tear.
• HERI Test — The arm is brought into hyperextension and internal rotation; a positive result reproduces anterior shoulder apprehension or pain, indicating anterior instability.
• Anterior Drawer Test — Direct anterior translation of the humeral head relative to the glenoid; compares side to side for anterior laxity.
• Fulcrum Test — The patient lies supine with the arm abducted over the edge of the table; the examiner provides a fulcrum under the proximal humerus while applying gentle external rotation. Apprehension indicates anterior instability.
• Rockwood Test — External rotation applied at 0°, 45°, and 90° of abduction to grade the degree of anterior instability; apprehension at lower degrees suggests more significant instability.
• Rowe Test — The examiner applies an anterior and inferior force to the proximal humerus with the arm in varying positions to assess anterior and inferior laxity.
• Protzman Test — Anterior stress applied with the arm in abduction; designed to assess anterior capsular laxity.

Posterior Instability

• Posterior Apprehension Test — The arm is brought into forward flexion, adduction, and internal rotation while the examiner applies a posterior force; apprehension or pain indicates posterior instability.
• Posterior Drawer Test — Direct posterior translation of the humeral head relative to the glenoid in a position of forward flexion and internal rotation; assesses posterior capsular laxity.
• Jerk Test — Axial compression applied through the humerus with the arm in 90° forward flexion and internal rotation, followed by horizontal adduction. A jerk or clunk on return indicates posterior labral or capsular pathology.
• Norwood Stress Test — Similar in principle to the Jerk test; applies axial load and horizontal adduction to reproduce posterior instability in the provocation position.

Inferior & Multidirectional Instability

• Sulcus Sign — Inferior traction applied to the arm with the shoulder in a neutral or slightly abducted position. A visible sulcus (dimple) below the acromion indicates inferior capsular laxity and possible multidirectional instability. Graded 1+ (<1cm), 2+ (1–2cm), 3+ (>2cm).
• Feagin Test — The patient drapes their arm over the examiner’s shoulder at 90° abduction; the examiner applies an inferior and anterior force. Reproduces inferior instability symptoms.
• Load and Shift Test — With the scapula stabilized, the examiner loads the humeral head into the glenoid and translates it anteriorly then posteriorly. Assesses glenohumeral laxity in both directions; useful for diagnosing multidirectional instability.

Thoracic Outlet Syndrome

These tests screen for thoracic outlet syndrome (TOS) by provoking compression of the neurovascular bundle between the clavicle, first rib, and anterior scalene. A positive result typically involves reproduction of symptoms and/or a change in the radial pulse.

• Adson’s Test — The patient extends and rotates the head toward the tested side and takes a deep breath. Obliteration or significant reduction of the radial pulse indicates TOS involving the anterior scalene.
• Allen Test — The arm is abducted to 90° and externally rotated; the patient rotates the head away from the tested side. Pulse change or symptom reproduction indicates vascular TOS.
• Roos Test (EAST Test) — The arms are held in 90° abduction and external rotation while the patient opens and closes the hands for three minutes. Inability to complete the test or reproduction of TOS symptoms (heaviness, paresthesia, pain) is a positive sign.
• Brachial Plexus Stretch Test — Lateral cervical flexion away from the tested side combined with shoulder depression; reproduction of radicular symptoms along the brachial plexus indicates neurogenic TOS or cervical nerve root involvement.
• Shoulder Abduction Test (Bakody Sign) — The patient places their hand on top of their head. Relief of cervical radicular or TOS symptoms with this position is a positive sign.

Other Shoulder Tests

• Apley’s Scratch Test — Three movements combining abduction/external rotation, adduction/internal rotation, and reaching behind the back to assess shoulder range of motion and approximate functional reach.
• Sternoclavicular Joint Stress Test — Direct compression or shearing force applied across the sternoclavicular joint; reproduction of local pain indicates SC joint pathology.
• Pectoralis Major Contracture Test — The patient lies supine with arms in 90° abduction and full external rotation; inability of the arms to reach the table indicates pectoralis major contracture.