Subacromial Impingement vs Rotator Cuff Tear Flashcards
Both Subacromial Impingement Syndrome and Rotator Cuff Tears share what common area of pain?
Anterior or Lateral Shoulder Pain
Pain may be increased during what time of day for both pathologies?
Pain that increases/worse at night
Differentiating factor on presentation for RTC tears vs Subacromial Impingement?
- Muscle Weakness
- Atrophy
Typical Ages of RTC tear?
Age > 40
How to Perform the Neer Test? Pathology Indicated
Subacromial Impingement:
PURPOSE- For impingement of supraspinatus and biceps tendon
DESCRIPTION- The patient’s arm is passively and forcibly fully elevated in the scapular plane with the arm medially rotated by the examiner. This passive stress causes the greater tuberosity to jam against the anteroinferior border of the acromion
RESULT- Reproduces symptoms of pain in the shoulder region
How to Perform the Hawkins-Kennedy? Pathology Indicated
Subacromial Impingement:
PURPOSE: Identify sub-acromial impingement
DESCRIPTION: The arm of the patient is passively flexed up to 90 degrees in the
plane of the scapula. The arm is stabilized and the forearm is forced into IR
RESULT: Pain indicates a positive test for supraspinatus paratenonitis/tendinosis or
secondary impingement
The Yocum test is a modification of this test in which the
patient’s hand is placed on the opposite shoulder and the
examiner elevates the elbow. Pain indicates a positive test
How to Perform the Yocum Test? Pathology Indicated
Subacromial Impingement:
The Yocum test is a modification of the Hawkins-Kennedy in which the
patient’s hand is placed on the opposite shoulder and the
examiner elevates the elbow. Pain indicates a positive test
How to Perform the Jobe/Empty Can Test? Pathology Indicated
Subacromial Impingement:
PURPOSE- Identify tear/ impingement of supraspinatus
tendon or suprascapular nerve neuropathy
DESCRIPTION- The patient’s arm is abducted to 90°
with neutral (no) rotation, and the examiner provides
resistance to abduction. The shoulder is then medially
rotated and angled forward 30° (“empty can” position)
so that the patient’s thumbs point toward the floor in the
plane of the scapula. Differentiate if pain is present
between two positions
RESULT- Reproduces pain in supraspinatus tendon
or weakness in empty can position
How to Perform the Painful Arc Sign? Pathology Indicated, Degrees of Pain?
Subacromial Impingement:
- 60 120 degrees of Active Shoulder Abduction
How to Perform the ER Lag Sign? Pathology Indicated?
Rotator Cuff Tear:
PURPOSE: To test the teres minor and infraspinatus. Also known as Infraspinatus
“Spring Back” Test.
DESCRIPTION: The patient is seated or in standing position with the arm by the side
and the elbow flexed to 90°. The examiner passively abducts the arm to 90° in the
scapular plane, laterally rotates the shoulder to end range and asks the patient to
hold it
RESULT: For a positive test, the patient cannot hold the position and the hand
springs back anteriorly toward midline, indicating infraspinatus and teres minor
cannot hold the position due to weakness or
pain
How to Perform the Drop Arm Test? Pathology Indicated?
Rotator Cuff Tear:
PURPOSE- Also known as Codman’s test. Identify tear/
full rupture of rotator cuff
DESCRIPTION- The examiner abducts the patient’s
shoulder to 90° and then asks the patient to slowly
lower the arm to the side in the same arc of movement
RESULT- A positive test is indicated if the patient
is unable to return the arm to the side slowly or
has severe pain when attempting to do so
How to Perform the Hornblower’s Sign? Pathology Indicated?
Rotator Cuff Tear:
PURPOSE: To detect Rotator cuff tears involving the teres minor
DESCRIPTION: The test is performed with the patient in the sitting or standing
position. The patient’s arm is supported at 90 degrees of abduction in the scapular
plane, with the elbow flexed to 90 degrees. The patient is then asked to rotate the
forearm externally against the resistance of the clinician’s hand.
RESULT: . If the patient is unable to externally rotate the shoulder in this position, the
horn-blower’s sign is said to be present
How to Perform the IR Lag Sign? Pathology Indicated?
Rotator Cuff Tear:
- Place Arm in IR behind the back lift arm off of back and ask patient to hold position
- Inability to hold position may implicated subscapularis tendon pathology
How to Perform the Lift Off Sign? Pathology Indicated?
Rotator Cuff Tear:
PURPOSE- To detect a lesion of the subscapularis muscle
DESCRIPTION- The patient places the dorsum of the hand on his back pocket or
against the mid-lumbar spine. (Great subscapularis activity is shown with the second
position). The patient then lifts the hand away from the back.
RESULT- An inability to do so indicates a lesion of the subscapularis muscle.
Bear Hug Test? Pathology Indicated?
Rotator Cuff Tear:
How to Perform the Belly Press? Pathology Indicated?
Rotator Cuff Tear:
PURPOSE: Checks the subscapularis muscle. Also k/a Belly-Press or Napoleon Test
DESCRIPTION: The patient is standing, examiner places a hand on the abdomen
below the xiphoid process so that the examiner can feel how much pressure the
patient is applying to the abdomen. The patient places his hand of the shoulder being
tested on the examiner’s hand and pushes the hand as hard as he can into the
stomach (medial shoulder rotation). While pushing the hand into the abdomen, the
patient attempts to bring the elbow forward to the scapular plane, causing greater
medial shoulder rotation.
RESULT: If the patient is unable to maintain the pressure on
the examiner’s hand while moving the elbow forward, or
posteriorly flexes the wrist or extends the shoulder, the test
is positive for a tear of the subscapularis muscle
