Shoulder dislocation.
1.Degas sign: also known as shoulder inversion test. The patient is asked to flex the elbow joint of the affected limb and then use the hand of the affected limb to buckle the opposite shoulder, if the elbow joint can be close to the chest wall that is normal, otherwise it is positive, indicating a shoulder dislocation. a positive Dugas sign can have three conditions: ① when the hand is on the opposite shoulder, the elbow joint cannot be close to the chest wall; ② when the elbow joint is close to the chest wall, the hand cannot be on the opposite shoulder; ③ both hand on the shoulder and elbow leaning are impossible.
2.Callaway test: Use a tape measure to measure the circumferential grip from the shoulder peak around the axilla. When the shoulder joint is dislocated, the humeral head is displaced forward and downward, thus overlapping with the scapula, and its anterior and posterior diameters widen, so the circumference increases.
3.Hamilton’s sign: also known as the straightedge test. A straight ruler is placed on the lateral side of the upper arm, first near the lateral epicondyle of the humerus and then near the skin of the upper arm. If the upper end is attached to the greater tuberosity, it is normal (negative); if it is not close to the greater tuberosity, but close to the shoulder peak, it is positive, indicating that the fat head is dislocated forward or the neck of the shoulder pedicle is fractured. This is because in normal people, the greater tuberosity of the hazel bone is outside the line between the acromion and the external nakedness of the fat bone.
4.Humeral long axis extension line test: A straight line is made along the long axis of the humerus, and when the shoulder joint is dislocated, the line can pass through the eye of the affected side.
5.Bryant’s sign: When the shoulder joint is dislocated, the axillary crease drops.
6.Shoulder triangle test: The triangle is formed by the three points of the shoulder crest, the howling process and the greater tuberosity. During dislocation, the position of the greater tuberosity changes, so the triangle is different from the opposite side.
Shoulder lock joint dislocation.
1.See the shrug test for scaphoid neck fracture.
2.See shoulder abduction test for shoulder splenic neck fracture.
Shoulder crest fracture and humerus fracture.
See shoulder abduction test for scaphoid neck fracture.
Scaphoid neck fracture.
1.See Hamilton’s sign for shoulder dislocation.
2.Shrug test: The patient sits upright with both arms naturally hanging down at the side. The examiner stands behind the patient and presses one hand on both shoulders, and then asks the patient to shrug his shoulders to compare the power of shrugging on both sides. The weakness of shoulder shrugging can be seen in clavicle fracture, acromioclavicular joint dislocation and trapezius muscle paralysis caused by paraneoplastic injury.
3.Shoulder abduction test: The patient takes a standing position, the examiner stands in the front side, presses his hands on both shoulders and palpates the compensatory activity of the scapula. Then, the patient starts the abduction movement from neutral position until he/she lifts over the head, and promptly explains when the shoulder pain starts and stops during the abduction process. The examiner notes the angle of abduction during pain.
Clinical significance of shoulder pain during abduction: ①Patients with pain at the beginning of abduction can be seen in humeral fracture, scapular neck fracture, clavicle fracture, shoulder dislocation, shoulder arthritis, etc. ②It is not painful at the beginning of abduction, but the closer the abduction is to the 90″ position, the more painful it is, probably because of shoulder joint adhesions. ③ Pain during abduction, but pain is relieved or not when lifting, it may be subacromial deltoid bursitis or subacromial bursitis. ④Patients who can actively abduct but are unable to continue to lift may have trapezius paralysis or upper brachial plexus palsy. ⑤ The middle section from abduction to supination (600- 120″) is painful, often called the “pain arc”, but less than this angle or greater than this range is not painful. If the supraspinatus muscle is completely severed, the active abduction range is less than 400, and if the examiner helps the upper arm to abduct passively above 400, the patient can continue the active abduction movement by himself. (6) If the passive abduction movement is more than 900, there is pain at the acromion and there may be a fracture of the acromion.
Tendonitis of the long head of the biceps tendon.
1. Yargason’s (Yargason’s) sign: also known as the long common tension test of the abductor brachii muscle. If the patient is asked to flex the elbow joint and rotate the forearm externally (posterior rotation) or have the patient flex the elbow and rotate the forearm posteriorly against resistance, if the pain at the groove between the nodes of the biceps tendon is positive, it indicates that there is biceps longus tendinitis.
2. Combing test: The action of combing the head is a combination of forward flexion, abduction and external rotation of the shoulder joint. If there is pain and limited or no movement when doing this movement, it indicates a shoulder joint disorder. For example, early stage of frozen shoulder, biceps longus tenosynovitis, ligament tears, joint capsule adhesions, subdeltoid bursitis, upper brachial plexus nerve palsy, axillary nerve palsy, etc.
Subacromial bursitis, subdeltoid bursitis, shoulder arthritis, shoulder joint adhesions and rotator cuff rupture.
1.Abduction test of shoulder joint: see scapular neck fracture.
2. Comb test: see biceps long head tenosynovitis.
Oblique muscle paralysis.
1.Shoulder abduction test: see scapular neck fracture.
2.Shrug test: see scapular neck fracture.
3.Shoulder abduction swing test: The patient takes a sitting position, the affected shoulder is abducted, the affected limb is elevated to 90° position, the examiner supports the affected limb to do back and forth swing, if there is shoulder pain, it is positive.
4.Anti-arch resistance test: The patient is seated, the affected limb is lifted over the top, while the examiner pulls the affected hand and instructs it to force and make a throwing motion from back to front, if there is pain, it is positive.
5.Top pressure grinding test: The patient lies on his back, the affected shoulder is abducted 60°, the elbow is flexed 90°, the examiner stands on the affected side, holds the affected elbow against the abdomen, supports the affected limb with both hands, presses the affected limb to the shoulder with force, while shaking the affected limb with both hands for grinding action, if there is pain, it is positive.
6.Daubahn’s sign: In acute subacromial bursitis, the upper arm of the affected limb is pressed against the side of the chest wall, and there can be tenderness under the front edge of the shoulder peak, if the upper arm is abducted, the bursa moves under the shoulder peak, and the tenderness disappears, it is positive.
7. Arm drop sign: In the case of supraspinatus injury, the abduction movement in the range of 30°-90° loses a control. Therefore, if the arm is passively abducted by 60°-90° and the support is removed, the affected limb will fall immediately and pain will be positive.
Compression of the subclavian artery.
Shoulder abduction and external rotation test: In the sitting position, when the shoulder is abducted 90° and externally rotated 90°, the flexor artery pulsation stops (or weakens) is positive, indicating the subclavian artery is compressed.
Rostral impingement syndrome.
Rostral impingement test: pain with clicking sound when the shoulder joint is in different angled horizontal inversion position, forward flexion and inversion is positive.