Special Tests: Rotator Cuff Pathology

Special Tests Covered in this Lesson:

• Park et al. Rotator Cuff Tear Testing Cluster
  
  • Infraspinatus Strength Test
  • Painful Arc Test
  • Drop Arm Test
• Supine Impingement Test (Screening Tool)

Rotator cuff pathology may be chronic, result from trauma, or may occur in conjunction with other diagnoses. For example, chronic rotator cuff pathology may be the result of biceps brachii and subscapularis tendonitis, or supraspinatus tendinopathy in conjunction with shoulder impingement syndrome. Both of these examples may be the result of scapula (shoulder blade) dyskinesis, which is likely to increase stress on the rotator cuff muscles during elevation of the upper arm. Acute trauma such as strains, rotator cuff tears, and shoulder dislocations (resulting in multiple tears) may occur during overhand throwing, falling on an outstretched arm, and/or direct impact on the arm or shoulder. Clinical professionals (physical therapists, physical therapy assistants, chiropractors, occupational therapists, athletic trainers, etc.) should be aware of the signs and symptoms of rotator cuff injury and the special tests (clinical tests) that may aid in diagnosing and screening patients and clients. Although some rotator cuff tears may require surgery to optimally regain function, partial tears are most often best treated with exercise and interventions intended to improve lower cervical and thoracic mobility, scapular (shoulder blade) dyskinesis, and shoulder stabilization and strengthening.

Special Note on Tests on Rotator Cuff Pathology and Shoulder Impingement Syndrome (SIS):

• There is a significant overlap between special tests for shoulder impingement syndrome (SIS) and rotator cuff pathology. A correlation between these diagnoses may be expected considering the contribution of supraspinatus and infraspinatus tendon inflammation to impingement pain, or the correlation between biceps tendon, supraspinatus tendon, and subscapularis tendons tears, or the contribution of rotator cuff pathology to altered recruitment, altered arthrokinematics, and subacromial compressive forces. Alternatively, when considered relative to the test positions for the majority of shoulder impingement tests , and the considerable amount of lengthening or tension created on rotator cuff muscles, it seems reasonable these tests may provoke symptoms in individuals with rotator cuff pathology as well.
• As mentioned in the course Special Tests: Shoulder Impingement Tests , special tests for SIS are sensitive but lack specificity. This may imply an accurate diagnosis of SIS during a physical examination is dependent on "negative test results for other diagnoses"(28). That is, positive results on tests are indicative of rotator cuff pathology, and would reduce the likelihood that anterior shoulder pain is solely related to SIS.
• In general, rotator cuff tests are more specific than impingement syndrome tests. In particular, the Park et al. Rotator Cuff Tear Testing Cluster , adds a significant amount of specificity to physical evaluation for shoulder joint pain, shoulder joint injury, and rotator cuff pain specifically.

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 particular, learning the Park et al. Rotator Cuff Tear (RC) Testing Cluster includes two of the three tests used in the Park et al. Shoulder Impingement (SIS) Test-item 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