We wrote quite an extensive series on shoulder impingement based on Cools algorithm from the year 2008. Through the use of several clinical tests, you should be able to identify the underlying pathological mechanism for the shoulder pain your patient is experiencing.
Usually, the problem with pain provocation tests is that they commonly rate low in terms of specificity. In other words, it’s practically impossible to isolate a single rotator cuff tendon from other structures such as the innervated bursae within the subacromial space, and form a diagnosis from the results.
The shoulder symptom modification procedure by Jeremy Lewis (2009) looks at shoulder impingement in a way that could be described as mechanical shoulder pain.
Once the general assessment process meaning: history taking, ROM, strength tests, and neurological testing is done the clinician and patient will identify the pain-provoking movement or positions
From there on a four-stage process begins. The painful movement is performed and the clinician applies an algorithm of the following procedures and assesses for symptom modification, in other words: pain reduction.
Meakins et al. (2018) evaluated the SSMP regarding its inter-rater reliability and found a moderate inter-rater reliability of k = 0.47
Let’s say flexion of the shoulder is painful.
One stage of the SSMP is targeting thoracic kyphosis. If your patient demonstrates increased thoracic kyphosis, techniques to actively extend the T-spine like ‘finger on the sternum’ can be used, or passive techniques like taping or manual therapy are applied and then the painful movement is reassessed for change in pain. If thoracic maneuvers reduce the pain by 100% the assessment is complete and treatment targeted at the thoracic spine would start.
If thoracic modification did not alleviate symptoms 100%, the position of the scapula is altered using manual techniques for simple movements or taping for complex movements. This may happen in several planes for example elevation or protraction, or a combination of movements.
This is different from the scapular assistance test where you are assisting the scapula to move. In scapular modification, you place the scapula in a new starting positing allowing it to move from that position without assistance.
If winging is apparent, manual stabilization or taping techniques are used. The painful movement is then reassessed.
The third stage concerns the positioning of the humeral head within the glenoid fossa. For example: using a neoprene sling or manual pressure, an AP or PA force is applied and the painful movement is reassessed.
Furthermore, the painful movement is executed whilst simultaneously contracting surrounding muscles, for example, the external rotators or humeral head depressors.
21 OF THE MOST USEFUL ORTHOPAEDIC TESTS IN CLINICAL PRACTICE
There are a couple of orthopedic tests that are used in the SSMP or related to this post that you might find interesting:
What customers have to say about the Assessment E-Book
The Assessment E-Book This book helped me in my studying for my exam and in assessing my first patients. Awesome! Also for beginners!
The Assessment E-Book It’s an amazing Compilation! Congrats to all the work you have put in there. You’ll propably find all the test’s you’ve been looking for with propper explaination and source to doublecheck for you self. definetly a must have for every student, but it will also help an experienced practioner. Im looking forward to the lifelong updates on the topics.
Great work, guys
The Assessment E-Book A must-have for all physiotherapists, osteopaths and manual therapists. The authors conducted an extensive research on assessment tests in manual therapy. I find it very easy to read. The more I read the more I learn. Thank you!
The Assessment E-Book This book is great! It is very structured and detailed. It works extremely well on my Macbook and iPad.
The Assessment E-Book The best way to spend 80euros. Totally worth it. The amount of work you put behind this must have been absolutely huge. Every physical or physiotherapist should own it.
Congrats guys you’ve done an incredible job.
I’ve learnd a lot of new things and my approach to therapy in general have totally changed.
In one word: amazing. Keep going guys ! Best wishes from france.
The technical storage or access is strictly necessary for the legitimate purpose of enabling the use of a specific service explicitly requested by the subscriber or user, or for the sole purpose of carrying out the transmission of a communication over an electronic communications network.
The technical storage or access is necessary for the legitimate purpose of storing preferences that are not requested by the subscriber or user.
The technical storage or access that is used exclusively for statistical purposes.The technical storage or access that is used exclusively for anonymous statistical purposes. Without a subpoena, voluntary compliance on the part of your Internet Service Provider, or additional records from a third party, information stored or retrieved for this purpose alone cannot usually be used to identify you.
The technical storage or access is required to create user profiles to send advertising, or to track the user on a website or across several websites for similar marketing purposes.