Apley’s Scratch Test

Apley’s scratch test is a quick method to test all the movements of the shoulder joint, it’s a common provocative tests in diagnosing frozen shoulder.

This test is one of the more frequently taught maneuvers for the evaluation of general shoulder motion and overall function.

How do you perform the Apley Scratch Test?

The patient may sit or stand. The examiner stands next to the patient.

The examiner asks the patient to reach behind his/ her head and touch the superior medial angle of the opposite scapula. This tests the abduction and external rotation movements.

Next the examiner instructs the patient to reach in front of his/ her head and touch the opposite acromion to determine internal rotation and adduction.

To further test this combination of movements, the examiner makes the patient reach behind his/ her back to touch the inferior angle of the opposite scapula.

See Also: Shoulder Range of Motion

What is a positive Apley’s Scratch Test mean?

Pain elicited in the rotator cuff and failure to reach the scapula because of restricted mobility in external rotation and abduction indicate rotator cuff pathology (most probably involving the supraspinatus).

The examination is made relative to the opposite side, as there is quite a large variation in range among normal subjects.

A differential diagnosis should consider osteoarthritis in the glenohumeral and acromioclavicular joints as well as capsular fibrosis.

See Also: Cross Body Adduction Test

Notes

Although the clinical utility of this test has yet to be defined, Apley Scratch Test is generally thought to be a quick and effective modality for the evaluation of global shoulder function.

Each of these movements is an active test of the functional mobility of the shoulder. Care should be taken to isolate movements that are restricted.

It is not uncommon for a patient to have slightly greater restriction on the dominant shoulder as compared to the nondominant shoulder due to increased muscle mass on the dominant side.

Apley’s Scratch Test is a very functional motion, because it is required for daily activities such as reaching a back pocket, cleansing the perineum, scratching the back, or fastening clothes.

Internal rotation is typically the first motion lost in adhesive capsulitis and the last to be regained. Patients with this condition are usually not able to reach even the lumbar spine. In these cases, the internal rotation is recorded by the nearest landmark reachable: the greater trochanter, the posterior superior iliac spine, the sacrum, and so forth

References

1. Batool H, Usman Akram M, Batool F, Butt WH. Intelligent framework for diagnosis of frozen shoulder using cross sectional survey and case studies. Springerplus. 2016 Oct 21;5(1):1840. doi: 10.1186/s40064-016-3537-y. PMID: 27818878; PMCID: PMC5074930.
2. Buchberger DJ. The prevalence of subscapularis dysfunction in a baseball population. Med Sci Sports Exerc 1 999;3 l (5) S262.
3. Clinical Tests for the Musculoskeletal System 3rd Edition.
4. Dutton’s Orthopaedic Examination, Evaluation, And Intervention 3rd Edition.
5. Sarvdeep S. Dhatt, Sharad Prabhakar – Handbook of Clinical Examination in Orthopedics. An Illustrated Guide-Springer Singapore.