Special Tests: Shoulder Impingement Syndrome (SIS)

Special Tests Covered in this Lesson:

• Park et al. Shoulder Impingement Testing Cluster
  • Hawkin's Kennedy
  • Infraspinatus Strength Test
  • Painful Arc Test
• Michener et al. Shoulder Impingement Testing Cluster :
  • Hawkins-Kennedy (Yokum)
  • Infraspinatus Strength Test
  • Painful Arc Test
  • Neer's Test
  • Empty Can Test
• Supine Impingement Test (Screening Tool)
  
  
  

Shoulder impingement syndrome (SIS) may result from repetitive use injury, or trauma, or may occur in conjunction with other diagnoses. For example, repetitive use may result in biceps tendonitis, subacromial bursitis, or rotator cuff tendinopathy. Acute trauma such as strains, rotator cuff tears, and dislocations can result in impingement pain due to changes in glenohumeral (shoulder) joint arthrokinematics and generalized inflammation of the glenohumeral and acromioclavicular (AC) joint tissues. The diagnosis of shoulder impingement syndrome (SIS), sounds "specific", but should be considered a broad diagnosis of anterior shoulder pain, especially with shoulder flexion or shoulder abduction. Clinical professionals (physical therapists, physical therapy assistants, chiropractors, occupational therapists, athletic trainers, etc.) should be aware of the signs and symptoms of SIS and the special tests that may aid in diagnosing and screening patients and clients. However, the special tests for SIS should likely only be used with additional special tests to "rule out" other diagnoses. Most often SIS is best treated with exercise and interventions intended to improve lower cervical and thoracic mobility, scapular (shoulder blade) dyskinesis, and shoulder mobility and strengthening.

Special Note on Shoulder Impingement Syndrome (SIS):

• Impingement is a diagnosis given to those experiencing anterior shoulder pain, which is usually dull and achy, and made worse by arm elevation. This type of shoulder pain is common to so many shoulder diagnoses, that "impingement" or "SIS" becomes a very broad label in practice, and may inadvertently encompass issues other than the compression and irritation of subacromial tissues (e.g. rotator cuff tear, labrum tear, anterior instability, etc.). Because these symptoms are common to many diagnoses, special tests for impingement generally suffer from a lack of specificity. A diagnosis of SIS may be most accurately reached when "a test-item cluster demonstrates a high likelihood of impingement and is accompanied by negative tests results for other diagnoses". When considering practice and evaluation, this may imply that shoulder impingement special tests are unnecessary, have little if any predictive value, and may not significantly influence practice (28).
  
  

Brookbush Institute Recommendation:

• The Brookbush Institute recommends that all clinical professionals are aware of these special tests (physical therapists, physical therapy assistants, chiropractors, occupational therapists, athletic trainers, etc.). In partice, learning the Park et al. Shoulder Impingement (SIS) Test-item Cluster includes two of the three tests used in the Park et al. Rotator Cuff Tear (RC) Testing Cluster . Adding the Drop Arm Test to the SIS cluster , or the Hawkins-Kennedy Test to the RC cluster results in 4 tests that can be used to accurately identify impingement and/or rotator cuff pathology. The Brookbush Institute recommends that if special tests for SIS are going to be used, they are used in this combined cluster to enhance the efficiency of shoulder evaluation protocols, and address some of the issues regarding the poor predictive value of SIS testing.
• Park et al. SIS and RC Tear Cluster
  
  • Hawkin's Kennedy
  • Infraspinatus Strength Test
  • Painful Arc Test
  • Drop Arm Test

For an Introduction to Special Tests

• For an introduction to Special Tests including definitions of specific terminology, what special tests measure, accuracy (specificity, sensitivity, reliability, etc.), how we chose the tests in each special test course lessons, and best practice recommendations:
• Special Tests: Introduction

Courses covering Special Tests for the Shoulder Girdle

• Special Tests: Shoulder Impingement Syndrome (SIS)
• Special Tests: Rotator Cuff Pathology
• Special Tests: Acromioclavicular (AC) Joint Pathology
• Special Tests: Shoulder Instability (Apprehension) and Labrum Pathology