Subacromial pain syndrome, formerly known as subacromial impingement is the most frequent cause of shoulder pain. It is an umbrella term for injuries of the subacromial space which include rotator cuff tendinopathy, partial-thickness tears, and bursitis. Michener et al. (2009) have come up with a test cluster for 5 different tests to diagnose subacromial pain syndrome. With 3 or more positive tests out of 5, the positive likelihood ratio increased to 2.93. Less than 3 positive tests lead to a negative likelihood ratio of 0.34. Due to the low change in post-test probability, this test battery has low clinical value in the diagnosis of subacromial pain syndrome.
The first test is the Hawkins-Kennedy test, which is said to compress the rotator cuff tendons in the subacromial space. To perform this test, bring your patient’s shoulder in 90° of forward flexion and support it on your arm by putting your hand on your patient’s unaffected shoulder. Then perform passive internal rotation. This test is positive if your patient’s familiar pain is reproduced.
The second test is the Neer test, which is also described to cause compression in the subacromial region. To perform this test have your patient in sitting position. With one hand depress the scapula, internally rotate your patient’s shoulder with your other hand and bring it into maximal flexion passively. This test is positive if your patient’s pain is reproduced.
The third test is the painful arc syndrome, which is described to compress the supraspinatus tendon in the subacromial space. To perform this test, have your patient in standing and ask him to slowly abduct his arms. This test is positive if your patient experiences pain between 45-60 and 120°of Abduction.
The fourth test is the empty can test, which applies tension to the supraspinatus via muscle contraction. To perform this test, have your patient standing and ask him to elevate his arms to 90° in the scapular plane. Then ask your patient to internally rotate his shoulders and to resist your force in a downward direction. This test is positive, if your patient’s familiar pain is provoked or if weakness is detected compared to the other side. Be aware, that the empty can test is not able to isolate the supraspinatus muscle and that up to 9 other muscles around the shoulder complex are active in this position.
The last test is resisted shoulder external rotation which also applies tension to the supra-and infraspinatus tendon via muscle contraction. To perform this test, have your patient in sitting position with his elbow flexed to 90° and the elbow close to the body. Then ask your patient to resist your internal rotation force. This test is positive, if you detect weakness compared to the other side or if your patient complains of his familiar pain.
21 OF THE MOST USEFUL ORTHOPAEDIC TESTS IN CLINICAL PRACTICE
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