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Home› Physical Therapy› Free Self-Checks› Special Tests› Shoulder

Shoulder Special Tests

Impingement, rotator cuff, labral and instability tests: how to do them, what a positive looks like, and what the research says about accuracy.

Reviewed by Dr. Richard Holsman, PT, DPT, NCS · Last reviewed November 13, 2026 · For clinician education

⚠️ For clinicians

For clinician education; special tests support but do not replace a full examination. This page is a reference for physical therapists, occupational therapists, athletic trainers, students and other clinicians. Patients with joint or spine pain should be examined by a licensed clinician.

Shoulder tests are best read as a group. Pooled data show that single tests for impingement and labral tears shift the probability only a little, while the instability tests and the lag signs are more useful when positive.

On this page

Accuracy at a glance

TestTarget conditionSnSp+LR−LRSource
Hawkins-Kennedy testSubacromial impingement (pooled, 7 studies)80%56%1.840.35[1]
Neer impingement signSubacromial impingement (pooled, 7 studies)72%60%1.790.47[1]
Painful arcSubacromial impingement (pooled, 4 studies)53%76%2.250.62[1]
Empty can testSubacromial impingement, weakness as positive (Michener, low risk of bias)50%87%3.900.57[1]
Drop arm testFull-thickness supraspinatus tear (Bak, high risk of bias)41%83%2.410.71[1]
External rotation lag signFull-thickness supraspinatus/infraspinatus tear (+ more below)46%94%7.20.57[2]
Belly press test (modified) and belly-off signSubscapularis tendinopathy, modified belly press (Bartsch, low risk of bias) (+ more below)80%88%——[1]
O’Brien active compression testSLAP lesion (pooled, 6 studies, original study excluded as an outlier)67%37%1.060.89[1]
Apprehension and relocation testsAnterior instability, apprehension (pooled, 2 studies) (+ more below)65.6%95.4%17.210.39[1]
Speed’s testSLAP lesion (pooled, 4 studies)20%78%0.901.03[1]
Yergason’s testSLAP lesion (pooled, 3 studies)12.4%95.3%2.490.91[1]

Sn = sensitivity, Sp = specificity, LR = likelihood ratio. A dash means the source we checked did not report that value.

How to read the accuracy numbers

  • Sensitivity: of people who have the condition, the share with a positive test. A highly sensitive test that is negative helps rule the condition out.
  • Specificity: of people without the condition, the share with a negative test. A highly specific test that is positive helps rule it in.
  • Positive likelihood ratio (+LR): how much a positive result raises the odds. About 5–10 is a moderate shift; above 10 is large.
  • Negative likelihood ratio (−LR): how much a negative result lowers the odds. About 0.1–0.2 is a moderate-to-large shift; near 1 means little change.
  • Values depend on the study’s patients, examiners and reference standard. Many studies are small, so treat single-study numbers with caution.

Shoulder special tests, step by step

Each test is described in our own words. Compare with the uninvolved side and stop if the test provokes severe pain.

Hawkins-Kennedy test

Also called: Hawkins impingement sign

Purpose
Provokes pain from the subacromial space (rotator cuff tendons and bursa) by driving the greater tubercle under the coracoacromial arch.
Patient position
Sitting or standing, arm relaxed.
How to perform[4]
  1. Raise the arm forward to 90° with the elbow bent to 90°.
  2. Support the elbow and stabilize the forearm.
  3. Rotate the shoulder inward by moving the forearm down toward the floor.
Positive finding
The patient’s familiar pain at the front or side of the shoulder.

Diagnostic accuracy

Target condition (source)SensitivitySpecificity+LR−LR
Subacromial impingement (pooled, 7 studies)[1]80%56%1.840.35
Abstract rounds to 79%/59%; table values shown.

Neer impingement sign

Purpose
Provokes subacromial pain by compressing the cuff and bursa against the anterior acromion in full elevation.
Patient position
Sitting or standing.
How to perform[4]
  1. Stand behind or beside the patient and hold the scapula down with one hand.
  2. With the arm turned in (thumb down), lift it passively forward into full flexion.
Positive finding
Familiar pain near the end of the movement.

Diagnostic accuracy

Target condition (source)SensitivitySpecificity+LR−LR
Subacromial impingement (pooled, 7 studies)[1]72%60%1.790.47

Painful arc

Purpose
Screens for subacromial pain during active elevation.
Patient position
Standing, arms at the sides.
How to perform[4]
  1. Ask the patient to lift the arm out to the side (in the plane of the body or the scapula) as far as possible and lower it slowly.
  2. Watch the face and ask where pain starts and stops.
Positive finding
Pain in a middle band of the motion (commonly about 60° to 120°) that eases above and below it.

Diagnostic accuracy

Target condition (source)SensitivitySpecificity+LR−LR
Subacromial impingement (pooled, 4 studies)[1]53%76%2.250.62

Empty can test

Also called: Jobe test, supraspinatus test

Purpose
Loads the supraspinatus to look for pain or weakness from tendinopathy or a tear.
Patient position
Standing or sitting.
How to perform[4]
  1. Raise both arms to 90° in the scapular plane (about 30° forward of straight out to the side).
  2. Turn the thumbs down as if emptying a can.
  3. Push down on both forearms while the patient resists; compare sides.
Positive finding
Weakness and/or familiar pain on the tested side. Record which one, because studies scored them separately.

Diagnostic accuracy

Target condition (source)SensitivitySpecificity+LR−LR
Subacromial impingement, weakness as positive (Michener, low risk of bias)[1]50%87%3.900.57
Single study reported in the review.

Drop arm test

Purpose
Screens for a larger, full-thickness rotator cuff tear.
Patient position
Standing.
How to perform[4]
  1. Passively lift the arm out to the side to about 90° or higher.
  2. Ask the patient to lower it slowly to the side.
Positive finding
The arm drops suddenly, or the patient cannot lower it smoothly, often with pain.

Diagnostic accuracy

Target condition (source)SensitivitySpecificity+LR−LR
Full-thickness supraspinatus tear (Bak, high risk of bias)[1]41%83%2.410.71
Single study reported in the review.

External rotation lag sign

Also called: ERLS

Purpose
Detects a full-thickness tear of the supraspinatus and/or infraspinatus by testing whether the cuff can hold the arm in external rotation.
Patient position
Sitting, back to the examiner.
How to perform[4]
  1. Support the elbow at 90° with the arm at about 20° of elevation in the scapular plane.
  2. Rotate the arm outward to just short of full external rotation.
  3. Keep supporting the elbow, let go of the wrist and ask the patient to hold the position.
Positive finding
The forearm drifts back inward (a lag). A larger lag suggests a larger tear.

Diagnostic accuracy

Target condition (source)SensitivitySpecificity+LR−LR
Full-thickness supraspinatus/infraspinatus tear[2]46%94%7.20.57
+LR from the review’s Table 1; sensitivity, specificity and −LR from the study abstract.
Full-thickness tear involving the infraspinatus (Castoldi, low risk of bias)[1]97%93%13.860.03
Single study reported in the review.

Belly press test (modified) and belly-off sign

Also called: Napoleon test

Purpose
Tests the subscapularis.
Patient position
Standing or sitting.
How to perform[4]
  1. Belly press: the patient presses the palm into the belly with the wrist straight and tries to bring the elbow forward, in front of the trunk.
  2. Belly-off: the examiner places the hand on the belly in maximal internal rotation with the elbow forward, then releases the wrist while supporting the elbow.
Positive finding
Belly press: the wrist bends or the elbow drops back behind the trunk to substitute. Belly-off: the hand lifts off the belly.

Diagnostic accuracy

Target condition (source)SensitivitySpecificity+LR−LR
Subscapularis tendinopathy, modified belly press (Bartsch, low risk of bias)[1]80%88%——
Single study reported in the review; LRs not shown because the review’s tables do not agree with each other.
Subscapularis tendinopathy, belly-off sign (Bartsch, low risk of bias)[1]86%91%9.670.14
Single study reported in the review.

O’Brien active compression test

Also called: Active compression test

Purpose
Intended for superior labral (SLAP) tears; also used for acromioclavicular joint pain.
Patient position
Standing.
How to perform[4]
  1. Flex the arm to 90°, bring it 10° to 15° across the body and turn the thumb down.
  2. Push down on the forearm while the patient resists.
  3. Repeat with the palm turned up.
Positive finding
Pain or a painful click deep in the shoulder with the thumb down that eases with the palm up (pain on top of the shoulder points more to the AC joint).

Diagnostic accuracy

Target condition (source)SensitivitySpecificity+LR−LR
SLAP lesion (pooled, 6 studies, original study excluded as an outlier)[1]67%37%1.060.89
Pooled data show little diagnostic value for SLAP lesions.

Apprehension and relocation tests

Also called: Crank apprehension; Jobe relocation; surprise (release) test

Purpose
Tests for traumatic anterior glenohumeral instability.
Patient position
Supine, shoulder at the edge of the table.
How to perform[4]
  1. Apprehension: abduct the arm to 90°, bend the elbow to 90° and slowly rotate the arm outward.
  2. Relocation: at the point of apprehension, push the head of the humerus backward with a hand on the front of the shoulder and continue rotating outward.
  3. Surprise (release): remove the backward pressure.
Positive finding
Apprehension: the patient feels the shoulder is about to slip out (fear, guarding), not just pain. Relocation: the apprehension eases with the backward push. Surprise: apprehension returns when the push is released.

Diagnostic accuracy

Target condition (source)SensitivitySpecificity+LR−LR
Anterior instability, apprehension (pooled, 2 studies)[1]65.6%95.4%17.210.39
Anterior instability, relocation (pooled, 3 studies)[1]64.6%90.2%5.480.55
Significant heterogeneity between studies.
Anterior instability, surprise (pooled, 2 studies)[1]81.8%86.1%5.420.25

Speed’s test

Purpose
Loads the long head of biceps; used for biceps tendon and SLAP problems.
Patient position
Standing, elbow straight, forearm turned up (palm up).
How to perform[4]
  1. Raise the arm forward to about 90°.
  2. Push down on the forearm while the patient resists.
Positive finding
Familiar pain in the bicipital groove at the front of the shoulder.

Diagnostic accuracy

Target condition (source)SensitivitySpecificity+LR−LR
SLAP lesion (pooled, 4 studies)[1]20%78%0.901.03
Pooled data show no diagnostic value for SLAP lesions.

Yergason’s test

Purpose
Loads the long head of biceps with resisted supination.
Patient position
Sitting or standing, elbow bent to 90° and held at the side, forearm turned down.
How to perform[4]
  1. Ask the patient to turn the palm up (supinate) and bend the elbow against your resistance.
Positive finding
Pain in the bicipital groove, or the tendon popping out of the groove.

Diagnostic accuracy

Target condition (source)SensitivitySpecificity+LR−LR
SLAP lesion (pooled, 3 studies)[1]12.4%95.3%2.490.91
Very specific but rarely positive.

Test clusters and prediction rules

Combinations of findings usually shift probability more than any single test.

Park cluster for impingement (any degree)

Items: Hawkins-Kennedy, painful arc and infraspinatus (resisted external rotation) strength test all positive.

Accuracy: Best combination for any degree of impingement: post-test probability 95%.[3]

Park cluster for full-thickness cuff tear

Items: Painful arc, drop arm sign and infraspinatus strength test all positive.

Accuracy: Best combination for full-thickness rotator cuff tear: post-test probability 91%.[3]

Michener cluster for subacromial impingement

Items: Hawkins-Kennedy, Neer, painful arc, empty can and resisted external rotation: 3 or more of 5 positive.

Accuracy: Sensitivity 75%, specificity 74%, +LR 2.93, −LR 0.34.[1]

Apprehension plus relocation (Farber) for anterior instability

Items: Both positive.

Accuracy: Sensitivity 81%, specificity 98%, +LR 39.68, −LR 0.19 (single study reported in the review).[1]

What we left out

Lift-off, hornblower’s, cross-body adduction, crank and passive distraction tests are not covered here. The Park 2005 single-test values are behind a paywall, so only its two clusters (from the abstract) are shown. We only show accuracy numbers we could check against the original study or review.

Sources, review and disclosures

Graded citations

How we grade sources. A = systematic review or meta-analysis. B = single prospective diagnostic accuracy study. C = small, retrospective or case-control study, or a clinical prediction rule that has only been derived (not yet validated). D = expert clinical opinion (our test descriptions). Every accuracy number on this page was checked against the cited abstract or full text on November 13, 2026. If we could not check a number, we left it out and say “accuracy data not verified.”

  1. Grade A Hegedus EJ, Goode AP, Cook CE, et al. Which physical examination tests provide clinicians with the most value when examining the shoulder? Update of a systematic review with meta-analysis of individual tests. Br J Sports Med. 2012;46(14):964-978. doi:10.1136/bjsports-2012-091066 (pooled values from Table 3; single-study values from Tables 1, 2 and 4). bjsm.bmj.com (full text)
  2. Grade B Miller CA, Forrester GA, Lewis JS. The validity of the lag signs in diagnosing full-thickness tears of the rotator cuff: a preliminary investigation. Arch Phys Med Rehabil. 2008;89(6):1162-1168. doi:10.1016/j.apmr.2007.10.046 (abstract). PubMed 18503815
  3. Grade B Park HB, Yokota A, Gill HS, El Rassi G, McFarland EG. Diagnostic accuracy of clinical tests for the different degrees of subacromial impingement syndrome. J Bone Joint Surg Am. 2005;87(7):1446-1455. doi:10.2106/JBJS.D.02335 (abstract). PubMed 15995110
  4. Grade D Holsman Physical Therapy clinical guidance. Patient position, test steps and positive findings written in our own words by Holsman physical therapists and reviewed by Dr. Richard Holsman, PT, DPT, NCS. Expert opinion, not a research source.

Reviewer

Reviewed by Dr. Richard Holsman, PT, DPT, NCS (Board-Certified Clinical Specialist in Neurologic Physical Therapy), founder of Holsman Physical Therapy. Last reviewed: November 13, 2026.

Change log

  • November 13, 2026: Page published. Test descriptions written in our own words; accuracy values checked against the cited sources.

Review policy

We re-check every number on this page against its source at least once a year, and sooner if a source is updated, a better study is published or a reader reports a problem. Changes are listed in the change log with the date. To report an error, contact us.

Licensing

Test descriptions, steps and the accuracy summaries are original text by Holsman Physical Therapy. Accuracy values are individual numbers cited with credit to the original studies; no tables, figures or text from journals, textbooks or other websites are reproduced. Linking to a source does not imply its endorsement. Demonstration videos, when added, will be filmed by Holsman physical therapists with consenting adult models.

Conflict of interest and advertising

This page is published by Holsman Physical Therapy and Wellness, P.C., which runs outpatient and in-home therapy practices; that is our only commercial interest. The page carries no advertising, no sponsorship and no affiliate links, and we received no payment from any source for it. Holsman Physical Therapy is not affiliated with the authors or publishers cited, and they do not endorse this website.

For clinician education; special tests support but do not replace a full examination. A positive or negative test changes the probability of a condition; it does not make a diagnosis. Interpret every result with the history, the rest of the examination, imaging when indicated, and clinical judgment. Stop any test that provokes severe pain or neurological symptoms.

Common Questions

Which shoulder special test is most accurate?

For anterior instability, the apprehension test had the strongest pooled positive likelihood ratio (17.2) in the Hegedus 2012 meta-analysis. For impingement and SLAP tears, no single test was accurate enough to confirm or exclude the diagnosis on its own.

Is Hawkins-Kennedy or Neer better for impingement?

Neither is strong alone. Pooled sensitivity was 80% for Hawkins-Kennedy and 72% for Neer, but specificity was only 56% and 60%, so a positive result raises the probability only a little. Use them with other tests and the history.

Referring a Patient?

Holsman physical therapists see patients at clinics across North Jersey, the Bronx and Brooklyn, plus in-home visits.

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