Clinical Examination of Shoulder & Rotator Cuff

There are multiple tests that are used for clinical evaluation of the subacromial impingement and cuff pathology. In the Neer’s Test, the patient should be standing or sitting upright. The examiner will passively elevate the pronated arm of the patient above the level of the shoulder. Pain at the anterolateral aspect of the shoulder indicates subacromial impingement. In the Hawkin’s test, the patient should be standing or sitting upright with the arm fully adducted and forwardly flexed. The elbow is also flexed. The examiner will place one hand on the patient’s shoulder and apply internal rotation to the effected arm with the other hand. Pain at the shoulder indicates subacromial impingement. In the Drop Arm test, the patient should be 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. A patient who is not suffering from a rotator cuff tear can lower the arm smoothly to the side. A patient suffering from a rotator cuff tear will not be able to hold the arm in abduction and the arm will drop rapidly. In the Belly-Press test, the patient should be standing with the hand of the affected arm at rest against the stomach with the elbow anterior to the midaxillary line. The patient is then asked to press the belling using the affected arm without moving the elbow. Failure to maintain the elbow anterior to the midaxillary line while pressing against the belly indicates subscapularis tear. In the Lift Off test, the patient should be standing with the affected arm internally rotated behind the back so that the dorsum of the hand will be resting on the lumbar area from the back. The examiner will passively lift the arm away from the patient’s back. Once the examiner releases the arm, failure to maintain the position of the arm away from the back indicates a subscapularis tendon tear. In the Adduction/External Rotation test, the patient should be standing with the affected arm abducted and the elbow flexed. The examiner will fully externally rotate the arm. With the release of the arm, failure to maintain active full external rotation indicates an infraspinatus tendon tear. Also, weakness of external rotation with the arm to the side could indicate an infraspinatus tendon tear. In the Jobe test, the patient should be standing or sitting upright. The arm should be anteriorly flexed at the level of the shoulder. The arm should be fully pronated into the “empty can position”. The patient should resist the downward force applied on the forearm by the examiner. Pain or weakness indicates a supraspinatus tendon lesion or tear.

Author
Nabil Ebraheim, MD

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