Clinical Shoulder Examination and Rotator Cuff Tests Explained

Join this channel to support the channel    / @nabilebraheim   Clinical evaluation of subacromial impingement and rotator cuff pathology. There are multiple tests used for the clinical evaluation of subacromial impingement and cuff pathology. We start with Neer’s test. The position of the patient: the patient is standing or sitting upright. The examiner passively elevates the pronated arm of the patient above the level of the shoulder. Pain at the anterolateral aspect of the shoulder indicates subacromial impingement. The Hawkins test. Position the patient standing or sitting upright with the arm fully adducted and forward-flexed. The elbow is also flexed. The examiner places one hand on the patient’s shoulder and applies internal rotation to the affected arm with the other hand. Pain at the shoulder indicates subacromial impingement. The Drop Arm test. Position of the patient: standing or sitting upright. The patient is asked to hold the affected arm in abduction at the level of the shoulder, then smoothly adduct the arm. Findings: in a patient without a rotator cuff tear, the arm can be lowered smoothly to the side. A patient with a rotator cuff tear will not be able to hold the arm in abduction, and the arm will drop rapidly. The Belly Press test is used to assess the integrity of the subscapularis muscle. Position of the patient: standing with the hand of the affected arm resting against the stomach, with the elbow anterior to the mid-axillary line. The patient is then asked to press the belly using the affected arm without moving the elbow. Failure to maintain the elbow anterior to the mid-axillary line while pressing against the belly indicates a subscapularis tear. The Lift-off test also evaluates subscapularis integrity. Position of the patient: standing with the affected arm internally rotated behind the back, so the dorsum of the hand rests on the lumbar area. The examiner passively lifts the arm away from the patient’s back. Positive finding: once the examiner releases the arm, failure to maintain the position away from the back indicates a subscapularis tendon tear. The Adduction External Rotation test. Position of the patient: standing with the affected arm adducted and the elbow flexed. The examiner fully externally rotates the arm. With release of the arm, failure to maintain active full external rotation indicates an infraspinatus tendon tear. Also, weakness of external rotation with the arm at the side may indicate an infraspinatus tendon tear. Jobe’s test. Position of the patient: standing or sitting upright. The arm is anteriorly flexed at the level of the shoulder, fully pronated into the “empty can” position. The patient resists the downward force applied to the forearm by the examiner. Pain or weakness indicates a supraspinatus tendon lesion or tear. Quizzes 1) Neer’s test is used to identify: A) Labral tear B) Subacromial impingement C) Biceps tendon rupture D) Glenohumeral instability Answer: B Explanation: Pain at the anterolateral shoulder during passive elevation indicates subacromial impingement. 2) In Neer’s test, the examiner: A) Passively elevates the pronated arm B) Externally rotates the shoulder C) Abducts and internally rotates the shoulder D) Applies downward pressure in abduction Answer: A Explanation: The test involves passive elevation of the pronated arm above shoulder level. 3) Hawkins test is positive when: A) Pain occurs with external rotation B) Pain occurs with internal rotation in flexion and adduction C) Pain occurs with passive abduction D) Weakness in external rotation is seen Answer: B Explanation: Internal rotation of the flexed, adducted arm causes pain in subacromial impingement. 4) Drop Arm test detects: A) Labrum tear B) Supraspinatus weakness C) Rotator cuff tear D) Biceps rupture Answer: C Explanation: Inability to lower the arm smoothly suggests a rotator cuff tear. 5) Belly Press test evaluates: A) Supraspinatus B) Infraspinatus C) Subscapularis D) Teres minor Answer: C Explanation: Pressing the belly while keeping the elbow forward tests subscapularis integrity. 6) Lift-off test specifically examines: A) Biceps tendon B) Subscapularis C) Teres minor D) Supraspinatus Answer: B Explanation: Inability to maintain hand lifted off the back = subscapularis tear. 7) Weakness of external rotation at the side indicates: A) Supraspinatus lesion B) Subscapularis weakness C) Infraspinatus tear D) Biceps rupture Answer: C Explanation: Infraspinatus is the main external rotator at the side. 8) Subacromial impingement is commonly detected by: A) Neer and Hawkins tests B) Jobe and Belly Press tests C) Drop Arm and Lift-off tests D) Speed’s and O’Brien’s tests Answer: A Explanation: Both Neer and Hawkins provoke impingement pain. 9) Which test best isolates supraspinatus function? A) Hawkins B) Neer C) Jobe’s D) Lift-off Answer: C Explanation: Jobe’s (empty can) isolates supraspinatus activity.