Subjective history and physical examination of the shoulder have been the cornerstones of the diagnostic process. Diagnosis based on physical tests are important, however studies have now been published that question the accuracy of these clinical tests.
Clinical testing should always be carried out after a thorough subjective examination- helping the clinician to clinically reason the pathology. According to Hughes et al (2008) and Hegedus et al (2008), the following tests may be clinically useful to identify Rotator Cuff pathology (see below for description of tests)
Rotator Cuff (RC):
The supine impingement test is a good test for general RC involvement but does not indicate any specific muscle.
The External Rotation Lag Sign is meant to test for integrity of the Supra and Infra spinatus
Drop arm test- is a good test for rotator cuff pathology, but again doesnt implicate a specific muscle
Bear Hug and Belly Press (Napoleon tests)-these are specific tests for subscapularis tendon pathology- A positive result is 20% weakness compared to the other side
Hughes et al (2008). Most clinical tests cannot accurately diagnose rotator cuff pathology: a systematic review. Australian Journal of Physiotherapy.54:159-170
Hegedus et al (2008). Physical examination of the shoulder a systematic review with meta-analysis of individual tests. BJSM. 42:80-92
DESCRIPTION OF TESTS:
The supine impingement test: The patient lies supine and the therapist passive abducts the arm to 180 with the palm is supination. The arm is then internally rotated- the test is positive if pain is produced.
The external rotation lag sign: The therapist takes the patients arm into 20 degrees of abduction and full external rotation (the elbow is flexed). The patient is asked to hold this position
The drop test: The patient is asked to lift the arm and slowly lower in the same way. Pain is reproduced on descent.
Bear hug: The patient places the painful hand on the opposite shoulder. The therapist tries to lift the hand from the shoulder. A positive test is one of weakness where the therapist is able to lift the patients hand
Belly Press: The patient puts their hand on their stmach with their elbow out to the side. the therapist tries to pull the patients hand from there stomach. A positive test is when the patients elbow drops back as they are unable to maintain internal rotation
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