Whipple Test | Subacromial Pain Syndrome | Supraspinatus Tears

According to Ackman et al. (2019), the Whipple test showed a sensitivity of 88.6% and a specificity of 29.4%.
Another diagnostic study by Sgroi et al. (2018) found a sensitivity of 68% and a specificity of 31%.
When looking at the resulting likelihood ratios which are approaching 1, we can conclude that this test has a weak clinical diagnostic accuracy and thus no usefulness in practice.

To perform the Whipple test the patient holds the hand of the affected shoulder palm-down in front of the contralateral shoulder and resists a downward force applied by the examiner. 

This test is classified as positive for pain in the shoulder and/or they weakness against the downward force compared with the contralateral arm.

Both studies we mentioned in the beginning also showed that neither the Whipple test nor the empty or full can test are capable to distinguish between partial- and full-thickness supraspinatus tendon tears. Keep in mind that EMG studies for example by Boettcher et al. (2009) show that it is impossible to isolate a single rotator cuff muscle and that for example more than 10 different muscles are active in the can test positions.

21 OF THE MOST USEFUL ORTHOPAEDIC TESTS IN CLINICAL PRACTICE

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Other common tests to assess for subacromial impingement syndrome are:

• Hawkins-Kennedy Test
• Neer Test
• Full Can Test
• Painful Arc Sign

References

Sgroi, M., Loitsch, T., Reichel, H., & Kappe, T. (2018). Diagnostic value of clinical tests for supraspinatus tendon tears. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 34(8), 2326-2333.

Ackmann, T., Schneider, K. N., Schorn, D., Rickert, C., Gosheger, G., & Liem, D. (2021). Comparison of efficacy of supraspinatus tendon tears diagnostic tests: a prospective study on the “full-can,” the “empty-can,” and the “Whipple” tests. Musculoskeletal surgery, 105(2), 149-153.

Boettcher, C. E., Ginn, K. A., & Cathers, I. A. N. (2009). Which is the optimal exercise to strengthen supraspinatus?. Medicine and science in sports and exercise, 41(11), 1979-1983.