Shoulder special tests earn their value when they confirm or refute a hypothesis you already formed from the subjective history - not as a checklist run on every patient. This guide gathers the tests that actually change management, grouped by suspected pathology, with how to perform each one and how to interpret a positive or negative result.
Sensitive screening tests - most useful for ruling subacromial pain out when negative rather than confirming it when positive.
Most specific when the apprehension–relocation–surprise cluster is positive together.
Labral tests are individually weak - cluster them with the history (overhead or traction mechanism, clicking, deep joint pain) before drawing conclusions.
No single labral test is reliable alone. For a suspected SLAP lesion, combine O'Brien's active compression, the biceps load II test and Speed's test with the history (overhead or traction mechanism, clicking, deep pain). For anterior labral or instability lesions, use the apprehension and relocation tests. Confirmation usually needs MR arthrography.
With the patient supine, elevate the arm to 120° abduction with full external rotation, elbow flexed to 90° and forearm supinated, then resist elbow flexion. Increased deep shoulder pain during resistance suggests a SLAP lesion.
There is no fixed must-do list - choose tests to confirm or refute the hypothesis your subjective examination suggested. For most painful, non-traumatic shoulders, a rotator cuff cluster (empty can, drop-arm, external rotation lag) plus Hawkins-Kennedy is a sensible starting screen.
In isolation most have only modest sensitivity and specificity. Diagnostic value rises substantially when tests are clustered for a single hypothesis and interpreted alongside the history and functional testing.
Both provoke the subacromial space. Hawkins-Kennedy uses 90° flexion with passive internal rotation; Neer uses passive overhead elevation in internal rotation. Both are sensitive but not specific, so they are most useful for ruling subacromial pain out when negative.
Mid-range pain (roughly 60–120° of active abduction) suggests subacromial pathology such as rotator cuff tendinopathy or impingement. Pain in the final 10–20° of elevation points more toward the acromioclavicular joint.