The Crank Test assesses whether axial loading and rotation of the elevated shoulder reproduces deep pain, catching, clicking or mechanical symptoms that may be associated with labral involvement. A positive finding may increase suspicion when it reproduces familiar deep shoulder symptoms, but it does not diagnose a labral tear or SLAP lesion on its own. Current SLAP/biceps anchor consensus literature emphasises that diagnosis requires history, examination, imaging and clinical context rather than a single special test.
A client reports deep shoulder pain, catching or clicking during overhead sport, pressing or throwing. Symptoms may feel internal rather than superficial. The Crank Test may help assess whether compressive rotation of the shoulder reproduces familiar mechanical symptoms.
The test should be interpreted cautiously. Clicking without pain is common and should not automatically be treated as a positive labral finding.
Test name: Crank Test
Body region: Shoulder, glenohumeral joint and labrum
Purpose: Assess symptom response to axial loading and rotation of the shoulder
Positive finding: Familiar deep shoulder pain, painful clicking, catching or mechanical symptoms during compression and rotation
Negative finding: No familiar symptoms during the manoeuvre
Best used with: Biceps Load II, O’Brien’s Test, Passive Compression Test, Apprehension Test, shoulder ROM and history
Key limitation: It does not diagnose a labral tear or SLAP lesion on its own
The Crank Test is a shoulder labral provocation test. The arm is elevated and an axial load is applied through the humerus while the shoulder is internally and externally rotated.
The purpose is to reproduce familiar deep shoulder pain or mechanical symptoms.
The test is used when labral or biceps-labral complex involvement is part of the clinical reasoning.
It may help assess clients with deep shoulder pain, clicking, catching, overhead sport symptoms, throwing pain or symptoms during loaded shoulder rotation.
The test assesses symptom response to compressed rotation of the glenohumeral joint. It does not isolate the labrum and does not confirm a tear.
Symptoms may also be influenced by biceps tendon, rotator cuff, instability, cartilage, joint surface or pain sensitivity.
This test may be useful for overhead athletes, throwers, swimmers, racquet sport athletes, gym clients and clients with deep shoulder symptoms or painful mechanical complaints.
Use when the client can tolerate shoulder elevation and rotation and labral involvement is part of the reasoning.
Use caution with acute instability, recent dislocation, severe apprehension, suspected fracture, recent surgery, high pain irritability or inability to tolerate overhead position.
Treatment table or chair
Pain and symptom scale
Measurz recording workflow
Optional comparison side notes
Position the client sitting or supine depending on the selected method.
Elevate the tested arm in the scapular plane or selected test position.
Stand beside the tested shoulder.
One hand supports the elbow or distal humerus. The other guides the wrist or forearm.
Control the scapula and humerus. Avoid sudden or excessive force.
Apply gentle axial compression through the humerus and rotate the shoulder internally and externally.
Ask the client to report deep pain, clicking, catching, grinding, instability, apprehension and whether symptoms are familiar.
A positive finding is reproduction of familiar deep shoulder pain, painful clicking, catching or mechanical symptoms.
A negative finding is no familiar symptoms during the manoeuvre.
Stop if pain increases sharply, apprehension occurs, instability symptoms appear, catching is painful or the position is not tolerated.
Do not force rotation or compression. Record whether clicking is painful and familiar.
A positive Crank Test may increase suspicion of labral or intra-articular shoulder involvement when it reproduces familiar deep pain or painful mechanical symptoms.
A negative test does not exclude a labral tear or SLAP lesion. Labral symptoms are variable and often overlap with biceps, rotator cuff and instability presentations.
Interpretation is stronger when combined with Biceps Load II, O’Brien’s, Passive Compression, instability testing, shoulder ROM, biceps testing, sport history and imaging where clinically relevant.
The Crank Test is used to assess possible shoulder labral involvement, including possible SLAP-related symptoms. More recent systematic review evidence suggests that SLAP/labral tests, including the Crank Test, have limited diagnostic accuracy when used alone. A positive Crank Test may increase suspicion of labral involvement, especially when it reproduces clicking, catching, pain, or a clunk, but it should be interpreted alongside client history, mechanism of symptoms, the Biceps Load II Test, O’Brien’s Test, and other shoulder assessments.
A 2025 clinical examination techniques paper on SLAP lesions describes labral examination as part of a broader assessment process and reinforces the need for careful test performance and interpretation.
Reliability depends on shoulder position, compression force, rotation range, symptom criteria and whether mechanical symptoms are familiar and painful.
Common errors include treating painless clicking as positive, applying too much compression, forcing rotation, not recording symptom quality, ignoring apprehension and using the test alone to diagnose labral pathology.
Limitations include low structural specificity, symptom overlap, mechanical noises in asymptomatic shoulders, pain irritability and limited current stand-alone diagnostic accuracy evidence.
Use the Crank Test to document symptom response to compressed shoulder rotation. It may help guide whether further labral, biceps, instability or imaging-related assessment is appropriate.
Record test name, side tested, result, pain score, symptom location, symptom quality, shoulder position, compression used, rotation direction, clicking/catching, whether symptoms were familiar, apprehension, comparison side, confidence in result and reason for stopping.
Add related findings such as Biceps Load II, O’Brien’s, Passive Compression, Apprehension, Relocation, shoulder ROM, biceps strength and overhead sport symptoms.
Biceps Load II Test
O’Brien’s Test
Passive Compression Test
Apprehension Test
Jobe’s Relocation Test
Load and Shift Test
Shoulder ROM Tests
Shoulder Strength Testing
It assesses whether compressed rotation of the shoulder reproduces deep pain or mechanical symptoms.
A positive finding is familiar deep shoulder pain, painful clicking, catching or mechanical symptoms.
Not by itself. Clicking is more meaningful when painful and familiar.
No. It may support clinical reasoning but does not diagnose a labral tear on its own.
Record side, pain, clicking or catching, shoulder position, compression, rotation direction and symptom familiarity.
The Crank Test is a shoulder labral symptom provocation test.
Painful familiar mechanical symptoms are more meaningful than painless clicking.
It does not diagnose SLAP or labral tears alone.
Use it with other labral and instability findings.
Measurz should capture symptoms, position, compression and mechanical response.
American Shoulder and Elbow Surgeons SLAP/Biceps Anchor Study Group. (2023). Evidence-based and consensus statement on pathoanatomy and diagnosis of clinically relevant superior labrum and biceps anchor disorders. Journal of Shoulder and Elbow Surgery. Needs verification.
Gismervik, S. Ø., Drogset, J. O., Granviken, F., Rø, M., & Leivseth, G. (2017). Physical examination tests of the shoulder: A systematic review and meta-analysis of diagnostic test performance. BMC Musculoskeletal Disorders, 18, 41. https://doi.org/10.1186/s12891-017-1400-0
Nuelle, C. W., et al. (2025). Superior labrum anterior posterior clinical exam techniques. Arthroscopy Techniques. Needs verification.
