RTC Instability/Impingement

Neer Impingement Test: Scapula is stabilized by the examiner, and arm is elevated into flexion by the examiner until report of pain. A positive test is pain in the anterior or lateral shoulder between 90 and 140 degrees.  Sensativity: 68%, Specificity: 68%

Hawkins Kennedy: Passively flex the patients arm to 90degrees within the plane of the scapula, stabilize the elbow which is bent to 90dgrees and internally rotate the shoulder.  Sensativity: 71.5%, Specificity: 66%

Painful arc: The patient elevates their arm in the scapular plane actively and complains of pain between 60 and 120 degrees.  Sensativity: 73.5%, Specificity: 81%.

Jobes Supraspinatus Test: Manual resistance  is applied to the arm with the the shoulder elevated to 90 degrees in the scapular plane with internal or neutral rotation. Sensativity: 44%, Specificity: 89.5%

Infraspinatus muscle strength test: Elbow is flexed to 90degrees and the arm is adducted to neutral.  Manual pressure is applied into internal rotation and the patient resists into external rotation. A postive test is giving way. Sensativity: 41.6%, Specificity: 90.1%.

Drop arm test: The patient is asked to elevate (or examiner passively elevates) arm fully and then is asked to hold and then slowly lower that arm.  A + test is if the arm drops suddenly or if the patient has severe pain holding it. Sensativity: 26.9%, specificity: 88.4%.

A combination of a + Hawkins Kennedy, + Painful arc and + infraspinatus strength test have a + likelihood ratio of 10.56 for having any degree of subacromial impingement.

A combination of a + Drop arm, + Painful arc and + infraspinatus strength test have a + likelihood ratio of 15.57 for having a full thickness RTC tear.

Citations:
Park HB, Yokoto A, Gill HS, Rassi GE, McFarland EG. Diagnostic Accuracy of Clinical Tests for the Different Degrees of Subacromial Impingement Syndrome. Journal of Bone and Joint Surgery. 87 (7): 1446-1455. Level 1 evidence.

Orthopaedic: Examination, Evaluation & Intervention. Mark Dutton. McGraw-Hill. New York; 2004.

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