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Empty can test: The patient is tested at 90° elevation in the scapula plane and full internal rotation (empty can) or 45°external rotation (full can). Patient resists downward pressure exerted by examiner at patients elbow or wrist.
External and Internal Rotation lag Signs Sreeram Penna
Belly Press / Napoleon Sign While in the standing position the patient puts a hand on the stomach and pushes as hard as possible. The effect is an isometric contraction with the shoulder in a position of internal rotation. At the same time the patient moves the elbow forward, which puts the shoulder in even more rotation. The test is positive for a tear in the subscapularis muscle if the patient can't press against the belly while rotating the shoulder.
Gerber’s Lift-Off Test: The patient is examined in standing and is asked to place their hand behind Their back with the dorsum of the hand resting in the region of the mid- lumbar spine. The dorsum of the hand is raised off the back by maintaining or increasing internal rotation of the humerus and extension at the shoulder. To perform this test the patient must have full passive internal rotation so that it is physically possible to place the arm in the desired position and pain cannot be a limiting factor during the manoeuvre.
The patient is examined in sitting with their arm at 90° and their elbow flexed to 90°, supported by the examiner to ensure maximal relaxation. The examiner then stabilises proximal to the elbow with their outside hand and with the other holds just proximal to the patient's wrist. They then quickly move the arm into internal rotation.
Anterior Apprehension test: Test for anterior labrum and anterior capsule
In supine the patient is positioned with the scapula supported by the edge of the examining table. The arm is positioned in 90 °abduction and external rotation. With increasing external rotation the examiner watches for apprehension on the part of the patient. This test is often performed in sitting in the clinic setting and the examiner exerts an anterior translatory force with their thumb placed posteriorly on the humerus. However their fingers are anterior to control any sudden instability episode that may occur.
The examiner repeats the apprehension test and notes the amount of external rotation before the onset of apprehension. They then return to the start position and apply a posterior stress over the humeral head. They then repeat the external rotation manoeuvre and again note amount of external rotation at onset of apprehension.
Anterior Drawer Test: Ideally this test should be performed with the patient in supine. The affected shoulder is held at 80-120° of abduction, 0-20° of forward Flexion and 0-30° of external rotation. The examiner holds the patients scapula spine forward with his index and middle fingers; the thumb exerts counter pressure on the coracoid. The scapula is fixed. The examiner uses his right hand to grasp the patient's relaxed upper arm and draws it anteriorly with a force comparable to that used in a Lachmann's test.
Gerber-Ganz Posterior Drawer Test - same as anterior drawer except with posterior force.
Sulcus Test: The patient is examined in sitting or standing and the shoulder is in a neutral position. It is important that the shoulder muscles are relaxed and that stress is applied above the elbow. (This eliminates the effect of the biceps and triceps brachii). With the arm grasped inferior traction is applied. The examiner watches for dimpling of the skin below the acromion. Palpation reveals widening of the subacromial space between the acromion and the humeral head.