Rockwood Adults CH34

1070

SECTION TWO • Upper Extremity

A

B

Figure 34-7.  A: Belly press test is done with the elbow bent in 90 degrees and the elbow forward. The patient is asked to hold the hand on the belly while resistive force is applied. Either weakness or pain is a positive test. B: Bear hug test is done with the hand on the contralateral shoulder. Resistance is applied and a positive test is either weakness or pain. Both tests are designed to evaluate for subscapularis rupture.

Specific tests for anterior instability include the anterior apprehension sign in which the arm is placed into an abducted (90 degrees) and maximally externally rotated (ABER) position with the patient in the supine position resulting in a feeling of pain, discomfort, and potential instability (Fig. 34-9A). From this position of ABER, the relocation test can conveniently be

performed in which a posteriorly applied force to the proxi- mal humerus will elicit a feeling of reduced apprehension or pain from the patient (Fig. 34-9B). Furthermore, an anterior release test (surprise test) can also be performed by removing the posteriorly directed force abruptly when the patient’s arm is in the 90 degrees of abduction, 90 degrees of elbow flexion,

A, B

C

Figure 34-8.  A: In the acute injury setting, testing of resisted shoulder abduction in the first 30 degrees of shoulder flexing with the arm internally rotated is effective for evaluating the supraspinatus. B: Jobe’s test or the empty can test are similar tests but performed traditionally with greater degrees of shoulder abduction which may be too painful for a patient who presents with a recent shoulder dislocation. C: Evaluation of the infraspinatus is performed by applying resisted external rotation with the elbow flexed to 90 degrees.