0:04 This is Brent of the Brookbush Institute, and 0:06 in this video we're doing the jerk test. 0:08 A special or orthopedic test for the 0:10 shoulder, that helps us indicate a 0:13 posterior inferior labral lesion. I'm 0:16 going to have my friend Melissa come out, 0:17 she's going to help me demonstrate. Now 0:19 this is kind of tricky, we have to 0:22 combine some actions that are not so 0:25 easy to combine; which is stabilization 0:27 of the scapula, we have to compress the 0:30 humeral head into the glenoid fossa, and 0:32 then we're going to simultaneously 0:34 horizontally adduct the humerus. So 0:38 here's what that looks like. We're going 0:41 to take this hand the hand closest to 0:43 the patient and we're going to put it 0:44 right over the top of the scapula, and 0:46 then our palm down over the back of the 0:47 scapula. We're going to take our other 0:49 hand using our lumbrical grip, that 0:51 little crab or lobster grip, we're going 0:53 to put that right over the elbow. Now 0:56 we're going to start at 90 degrees of 0:58 abduction, and roughly 90 degrees of 1:00 shoulder internal rotation here, and I'm 1:02 now going to press her humerus into her 1:06 glenoid fossa. So my force will always be 1:09 directed in line with the humerus itself, 1:12 an axial load so to speak, and so we're 1:17 going to push in this way, and then 1:19 here's where it gets tricky. Maintaining 1:21 that load I'm going to horizontally adduct 1:24 the humerus, while asking my 1:28 patient does that replicate your 1:30 symptoms? Yeah. that's what you were 1:32 complaining about. Where do you feel that? In 1:36 the back of her shoulder. Alright so a 1:39 positive Jerk test is the onset of pain 1:44 in the back of the shoulder, with or 1:47 without clicking. Of course clicking you 1:49 can either hear or feel as you're going 1:51 through the test. The most important 1:53 thing is it does it replicate your 1:54 patient symptoms. I'll show you guys a couple of 1:57 other views here. Let me have you move 1:59 this way Melissa. I just want you guys to clearly see 2:01 the mechanics of this. Notice hand, top 2:04 and then bracing the back of your 2:06 scapula. I also have good control over 2:08 her torso here. I'm then going to use 2:11 this grip 2:12 over her elbow, and then notice i get my 2:15 elbows up nice and high so that my forearms 2:19 match my directions of force pretty good. 2:22 This is going to make it a lot easier on 2:24 me, and then all i have to do is take a 2:26 step and I can take her into a 2:30 horizontal adduction, while maintaining 2:32 that force in line with the humerus, 2:35 compressing the humeral head, and I'm 2:37 going to ask her is that the symptoms 2:39 you were talking about? Where do you feel 2:41 that? In the back of your shoulder, all 2:45 right positive Jerk test. Alright go 2:46 ahead and flip all the way around .One 2:49 last view of my mechanics here. So this 2:54 hand over the top stabilizing the back 2:58 of the scapula. This hand over the top of 3:01 her elbow, bracing her humerus, I've got 3:04 good control here, I'm going to get my 3:06 elbows up nice and high. I'm just going 3:08 to take a step as I continued to 3:11 compress her humeral head into her 3:16 glenoid fossa, and of course all the 3:18 while I'm asking does that match the 3:22 symptoms you were talking about, is that 3:24 what you were complaining about, where 3:25 did you feel that. Alright, thank you Melissa. 3:29 Now if I'm doing the Jerk test that's 3:33 just one clue towards an assessment or 3:37 diagnosis of what may be contributing to 3:40 my patients complaints, I'm going to do 3:44 other tests to confirm this assessment 3:46 or diagnosism chances are if I've done 3:49 the Jerk test I'm also going to do the 3:51 Kim's test, because that's my other 3:52 posterior inferior labral lesion test. 3:55 Chances are I've already done my SLAP 3:59 lesion tests. Things like the O'Briens 4:02 active compression test and and maybe 4:04 even Speeds, but I want to make sure that 4:07 as I'm putting this together, I'm putting 4:09 all my clues together, I have some 4:11 negatives to ensure that it's not that 4:14 diagnosis, it's not like a SLAP tear. 4:16 Maybe I've done my impingement tests, my 4:20 rotator cuff tests, and I know if those 4:23 are negative but these are positive I'm 4:26 really really on the right track. Now 4:28 chances are you're going to get a mixed 4:30 bag, and you're also going to have to 4:32 match it up with a subjective evaluation. Now 4:35 why is this all important, with our 4:37 diagnostic testing you have to keep in 4:39 mind is this patient going to get better 4:42 with conservative treatment, i.e manual 4:44 therapy and exercise. Or should I refer 4:47 out to a physician, because there's a 4:49 chance that we need some imaging maybe 4:52 to make a better decision. Or is there a 4:54 chance that surgical intervention is 4:57 actually going to be the better solution 5:00 for this patient right. You don't 5:04 necessarily have to make that decision, 5:05 if you are leaning towards a significant 5:09 labral lesion that could need surgical 5:12 intervention, personally I would go ahead 5:15 and refer up to a physician, try to get 5:18 some imaging, maybe talk with that 5:19 physician and may be jointly we decide 5:22 whether we should try conservative 5:24 treatment at all, or we should skip 5:27 straight to surgical intervention. I hope 5:30 you guys enjoyed this video, give this 5:32 test a try, it's a little tricky. I would 5:34 practice it before using it in the 5:36 clinic. If you have any questions leave a 5:38 comment below. 5:47
