Shoulder and upper arm diagnoses

Evaluation

Rotator Cuff Tests

  • Supraspinatus Test
    • Abduct arm to 90', forward flex it 30' with thumb down ("empy beer can position")
    • Test for pain/weakness against resistance to continued abduction
  • Infraspinatus and Teres Minor Test
    • Stabilize the elbow against the patient's waist and bend the elbow to 90'
    • Test for pain/weakness against resistance to external rotation
  • External rotation lag sign - more specific to teres minor, given overlap between infraspinatus and teres minor[1]
    • Support the arm to 20-30 degrees in scapular plane, externally rotated, elbow flexed to 90 degrees
    • Positive test is pain or difficulty in keeping the arm from internally rotating when clinician lets go
  • Subscapularis
    • Place hand behind lower back
    • Test for pain/weakness as patient attempts to push examiner's hand away by moving dorsum of hand away from back
  • Drop arm test
    • Patient is unable to hold or smoothly lower an extended arm at 90' of shoulder abduction with out dropping it

Impingement Tests

  • Maneuver of Neer
    • Prevent scapular rotation with one hand while rasing patient's straightened arm in full forward flexion to overhead
    • Positive sign is pain in the arc bewtween 70-120'
  • Hawkins Impingement Test
    • Position the shoulder at 90' of abduction and elbow at 90' of flexion
    • Then rotate shoulder internally bringing the arm across the front of the pt
    • Positive sign is pain during this maneuver

Differential Diagnosis

Shoulder and Upper Arm Diagnoses

Traumatic/Acute:

Nontraumatic/Chronic:

Refered pain & non-orthopedic causes:

See Also

  • Collin P et al. What is the Best Clinical Test for Assessment of the Teres Minor in Massive Rotator Cuff Tears? Clin Orthop Relat Res. 2015 Sep;473(9):2959-66.