Special Tests for Shoulder Injuries〜Part 2〜

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The same as the last time, special tests for shoulders that have been frequently used by orthopedists specialized for shoulders are introduced. I believe that all athletic trainers should know them.

This posts focuses on special tests that identify rotator cuff injuries. 


>>Please read the last post if you have not read it.

Special Tests for Shoulder Injuries 〜Part 1〜


>>The study and textbook referred for this post:

scsho

Frequency of Use of Clinical Shoulder Examination Tests by Experienced Shoulder Surgeons

An article from Journal of Athletic Training

 

pic for ortho

「Orthopedic and Athletic Injury Examination handbook」

A textbook for an athletic training program I graduated

 

 

 

Rotator Cuff Injuries

Seven special tests have been used by more than 50% from 71 orthopedists to identify rotator cuff injuires.

 

Belly Press Test

This “Belly Press Test” was the test that was most frequently used by the orthopedists to identify rotator cuff injuries. 

Among the rotator cuff muscles, this test identifies damage to subscapularis muscle, which is an internal rotator of the shoulder. 

 

1)A patient should be sitting or standing position.

2)The patient bends his/her elbow to 90 degrees and puts the hand on his/her stomach.

3)An athletic trainer puts his/her own hand between the patient’s hand and stomach.

4)The trainer supports the patient’s elbow with another hand.

5)While holding the elbow, the trainer pushes the patient’s hand away from the stomach.

6)The patient resists the force provided by the trainer to keep the hand close to the stomach.

7)Positive if pain occurs or the patient’s hand comes off the stomach.

【Cautions】Pay attention to watching compensation of the movement. 

If the patient cannot perform the internal rotation of the shoulder to resist force applied by the trainer, the patient may use the wrist flexion to resist the force, which is not the desired movement of this special test. 

Even if the patient can resist the force itself applied by the trainer, the resistance may not be from the internal rotation of the shoulder. Patients ALWAYS try to win the trainer’s force. Therefore, the trainer should watch his/her movement during the special test and judge whether the test is positive or negative. 

 

Drop Arm Test

“Drop Arm Test” checks if there is damage/an injury to the suprasupinatus.  

 

1)A patient should be sitting or standing position.

2)An athletic trainer basically just watches the shoulder movement during the test. 

3)The trainer holds the patient’s arm tested and externally rotates the shoulder.  From there, lift the patient’s arm to the position of 180-degree of shoulder abduction (fingers toward the sky).  ※A start position of this test should be 180-degree of shoulder abduction although the movie above shows 90-degree of shoulder abduction.

4)The trainer now releases the patient’s hand. The patient keeps it up there.

5)The patient then slowly lowers the hand down while keeping the elbow straight. 

6)Positive if pain occurs when lowering the arm, or the arm is suddenly dropped off due to no strength.  

Supraspinatus rupture is suspected if this test is positive. 

As stated in the Belly Press test, the patient may use different muscles or tilt his/her body to the opposite side to compensate the movement or keep the arm up if the patient cannot perform this test well due to the damage of rotator cuff muscle.

The trainer needs to watch the patient’s movement during the test carefully.

 

Empty-can Test

The same as the Drop Arm Test, this Empty-can test 

 

1)A patient should be sitting or standing position. 

2)An athletic trainer abducts the patient’s shoulder at 90 degrees on the plane of the scapula and then internally rotates it (the thumb toward the ground).

3)The trainer supports the patient’s shoulder with one hand, holds his/her wrist or forearm from the top with another hand, and applies force downward.

4)The patient resists the force to keep the arm at that position. 

5)Positive if pain occurs, or the patient cannot resist the downward force.

 

Lift Off Test

The same as the Belly Press Test, this test checks if there is damage to subscapularis muscle.

 

1)A patient is a standing position.

2)The patient bends the elbow at 90 degrees and places the back of hand on the center of low-back. 

3)The patient lifts the hand backward away from the low-back.

4)Positive if the patient cannot lift the back of hand backward away from the low-back. The damage to the subscapularis is suspected.

Just reminder, as same as previous tests, that the trainer should pay attention to compensation movement by the patient.

 

Hornblower Test

This test is performed to check on infraspinatus and teres minor muscles. 

 

1)A patient should be a sitting or standing position. 

2)A tested shoulder is abducted at 90 degrees on the plane of the scapula.

3)From that position, the elbow is also bent at 90 degrees.

4)Then the clinician applies force to the direction of internal rotation of the shoulder. The patient resists the force applied by the clinician, which means that the patient creates the resistant force towards external rotation of the shoulder. 

5)Positive if the patient cannot resist the force applied by the clinician.

 

External-rotation lag test

This test checks whether or not there is rupture of either supraspinatus or infraspinatus. 

 

1)A patient is a sitting position.

2)An elbow of the tested arm is bent at 90 degrees.

3)A clinician brings the arm up about 20 degrees of shoulder abduction on the plane of the scapula. 

4)Keep that position, and externally rotate the shoulder to a maximal degree. 

5)The clinician releases the arm at the position. The patients keeps it up there. 

6)Negative if the patient can keep it up. Positive if the patient cannot. Either supraspinatus or infraspinatus rupture is suspected.

 

We cannot say that special tests that have been frequently used by orthopedists are reliable; however, you can definitely use this information as reference. 

 

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