Acromioclavicular fx, Drop arm test, Shoulder drawer / Glide test

(In general, the presence of palpable crepitus is suggestive of a fracture necessitating radiographic studies.)

Acromioclavicular separation:

• Discreet tenderness at the acromioclavicular joint with no crepitus and a palpable step-off is characteristic of an acromioclavicular separation.
• Although infrequent, this injury occurs most commonly in older, skeletally mature athletes during a fall on the lateral shoulder or a collision following a downward blow to this anatomic area.
• Similar trauma in skeletally immature children is more likely to cause a fracture of the distal clavicle.
• A grading system has been established based on the severity of the separation.

• Scarf sign –cross-chest adduction (reach across body) causes Acromioclavicular joint pain - indicative of fracture

The Drop Arm test

• The "drop arm" test aids in detecting a rotator cuff tear.
• The examiner abducts the patient's arm 90 degrees and instructs the patient to lower the arm slowly to the side.
• The test result is positive if pain is created by movement of the arm to the side.

Evaluation of scapular stabilizers

• Pain elicited by having the athlete press his or her hands together in front of the body (not specific for an acromioclavicular separation). "Winging" of the scapula indicates weakness of the serratus anterior muscle.

Shoulder drawer or glide test

• The "shoulder drawer" or "glide" test is performed with one of the examiner's hands on top of the patient's shoulder for stabilization of the clavicle and scapula while gripping the head of the humerus with the other hand.
• Results of this maneuver, which is helpful in assessing glenohumeral joint injuries, are considered positive if humeral subluxation elicits pain.

References:
Hergenroeder A, Chorley JN. Shoulder injuries. In: Behrman RE,
Kliegman RM, Jenson HB, eds. Nelson Textbook of Pediatrics. 16th ed.
Philadelphia, Pa: WB Saunders Co; 2000:2103
Huurman W, Ginsburg GM. Musculoskeletal injury in children. Pediatr
Rev. 1997;18:429-440
Landry GL. Sports medicine. In: McMillan JA, DeAngelis CD, Feigin RD,
eds. Oski's Pediatrics: Principles and Practice. 3rd ed. Philadelphia,
Pa: Lippincott Williams & Wilkins; 1999:732-751
Pasque CB, McGinnis DW, Yurko-Griffin L. Shoulder. In: Sullivan JA,
Anderson SJ, eds. Care of the Young Athlete. Rosemont, Ill, Elk Grove
Village, Ill: American Academy of Orthopedic Surgeons and American
Academy of Pediatrics; 2000:329, 335-338