Execution
- 1Position the patient in upright sitting.
- 2Stand posterolateral to the shoulder being examined.
- 3Palpate the spinous process of C7 and place the thumb contralateral to the tested shoulder against the spinous process.
- 4Ask the patient to actively flex the shoulder maximally.
- 5Assess whether terminal shoulder flexion is coupled with contralateral rotation through the cervicothoracic junction.
Positive outcome
The test is abnormal if the C7-T4 region does not show the expected coupled contralateral rotation during maximal shoulder flexion. The finding suggests cervicothoracic mobility restriction contributing to limited shoulder elevation.
Studies
| Study | Reliability | Sn | Sp | LR+ | LR− |
|---|---|---|---|---|---|
| Baertschi et al. (2013) | κ = 0.63-0.84 | NA | NA | NA | NA |
CommentThis test reflects the broader point that end-range shoulder elevation can involve thoracic spine and rib movement. It should not be interpreted as a standalone thoracic diagnosis. Reliability evidence is limited to mobility-test agreement, not diagnostic accuracy.