0:04 This is Brent of the Brookbush Institute, and in this video we're going over the 0:07 Michener et al. impingement testing cluster. I'm excited to bring you guys 0:10 these videos, because finally it brings together all of the special test videos 0:15 as we would actually use them in clinic. I'm going to have my friend Alyssa come 0:20 out she's going to help me demonstrate this testing cluster. Now the Michener et 0:24 al. cluster uses the Neer test, the Hawkins-Kennedy test, something that 0:29 looks like the infraspinatus test which is basically an external rotation 0:32 strength test, we're going to do the empty can test, and then we're going to 0:36 do the painful arch test. If she gets a positive on three or more of these tests 0:41 that's a good indication that she has impingement syndrome. Alright that's a 0:47 stronger diagnosis for impingement syndrome than any one of those tests 0:50 alone. Alright so let's go ahead and go through these tests. So Neer, I'm gonna 0:54 take her into internal rotation all the way through, all the flexion she has in 0:58 the scapular plane. Notice I'm stabilizing her scapula so she doesn't 1:02 go into a bunch of elevation. At her end range i'm going to give her a little 1:06 over pressure and ask her does that hurt? Is that your symptoms? No pain, that's not 1:12 the symptoms she was talking about. Alright so that's negative, next we're 1:16 going to go through the Hawkins-Kennedy, so this hand goes in the same position, I 1:19 want to keep that scapula from going into upward rotation because this is a 1:23 shoulder test, and then I can use my palm to stabilize your torso so I don't push 1:27 her off the table. I'm going to go ahead and take that lumbrical grip over her elbow, 1:31 90 degrees of horizontal adduction, 90 degrees of flexion and I'm going to 1:35 twist. How does that feel? Hey that hurts a little bit, okay so we have a positive 1:40 Hawkins-Kennedy, now we're going to do that external rotation test. Now this is 1:46 one I demonstrate. I don't want her to try and use her deltoids to push 1:49 out against me. So I want you to turn your arm so that you're 1:53 pushing out with like, more like your wrist, okay. Alright go ahead and push out, 1:58 and she's strong, it's all those big muscles she's got, so she's nice and 2:03 strong there. So that's negative for that test. Next we're going to do the empty 2:07 can test. So she's going to start in abduction this way, I want you to go 2:13 ahead and resist me, I'm going to note how strong she is in this position, 2:17 and she is super strong, I can do a push off of this position, all right. Then I'm 2:22 going to have her turn her thumbs down and I'm going to put her in the scapular plane, 2:26 which was 30 degrees of horizontal adduction. I'm going to have her go ahead 2:31 and try to resist again, and note if she has any marked weakness in this position 2:35 or this provokes her symptoms or pain on the symptomatic side, so once again we're 2:41 negative for this test. And then the last test you're going to do, go ahead and 2:46 stand up, is the painful arch test. So what I want you to do is I need you to tell 2:52 me when the pain starts, when it's at its worst and when it goes away, as you 2:59 slowly move your arm all the way up as high as you can. I want you to go 3:04 sideways with it though like this, okay ready ? Go, okay no pain. 3:11 Oh okay, so we have no pain on painful architects, that's a negative to that 3:16 test. You can go ahead and sit down. So we had negative to everything but the 3:22 Hawkins-Kennedy. So pretty good indication that you don't have 3:26 impingement syndrome, or if you do have some start of impingement syndrome 3:30 because of the Hawkins-Kennedy thing it's not very bad. The idea behind these 3:34 testing clusters is that would be strong diagnostic criteria that we need to look 3:42 for something else that is causing her problems. Now let's set up a little 3:48 patient scenario and test your acting skills. Alright we're going 3:51 to say Alyssa is a swimmer, which I'm not even sure if you are a swimmer but 3:55 if you are great. Alyssa is a swimmer and three months ago she started having a 4:00 little pain while she was swimming. It progressively got worse and now you're 4:05 seeing me, because you noticed that even when she tries to like push open a heavy 4:09 door she gets anterior shoulder pain. So we had that kind of chronic onset, she 4:14 can't remember a single instance that hurt her shoulder, it's just been getting 4:18 progressively worse over time. So we have a pretty good subjective analysis that 4:24 leads us to believe that impingement syndrome might be your problem. So we're 4:28 going to do this Michener et al. cluster. You ready? We're going to do it 4:32 again, you got the scenario in your head? Yeah. Alright so first first thing we're 4:37 going to do is the Neer test, internal rotation stabilize the scapula, all the 4:42 way through all available flexion in the scapular plane, a little bit of 4:45 overpressure. How do you feel? No pain. No pain, okay so she has no pain there. Next 4:52 I'm gonna take her into Hawkins -Kennedy and you guys saw that she was positive 4:56 before this, so yeah this is definitely positive. Is this the symptoms you 5:01 feel when you're swimming? It is, ok good. Let's try the external rotation test 5:06 here, so she's going to go ahead and push out, good. 5:10 how about that? That hurts a little bit. That hurts a little bit, all right so so 5:14 far we have positives on the Hawkins-Kennedy, we have positive on the external 5:19 rotation test for pain, and even I notice like she's a little weak here and you 5:23 guys will see that a lot with people who have pain in this position, is it's not 5:26 it's not that they can't push out against you they won't be able to 5:29 maintain, and if we were to compare sides this side would probably be a little 5:33 weaker. Alright the next test that we're going to do is the empty can test, 5:38 so I'm going to have you go ahead and pull out like this. Alright I'm going 5:41 to note her strength in this position, good. She's a little weak in that position but 5:47 let's compare it to this one, alright good and she's even weaker in this 5:54 position. How does this feel? Alright it feels really hard, yeah it doesn't feel 5:59 good. So we have a positive empty can test, we even notice she was 6:04 a little weak on the full can test there, and then go ahead and stand up for me. Alright now 6:09 once again with this painful arc test I need you to tell me when the pain starts, 6:14 when it's at its absolute worst, and then when it starts to go away. As you take 6:18 your arm all the way through your total range of motion out to the side here. 6:24 It's starting right now, this is the worst. 6:31 Okay, okay good go ahead and sit, all right so we now have positives for the 6:38 Hawkins-Kennedy, the external rotator strength test, we have a positive for the 6:42 empty can test, and it was positive for the painful arch test. Four out of five on 6:47 the Michener et al cluster is more than three out of five. So i would say 6:51 you're positive for impingement syndrome. Now just like the Park et al. 6:55 cluster we talked about in an earlier video, despite the fact that these 7:00 clusters are better diagnostic tools than any one of these tests, in fact I've 7:04 talked in some of the other videos where I explain each one of these tests, some 7:09 of these tests are pretty bad individually, even though they're better 7:13 together, the diagnosis of impingement is a fairly poor indicator of what we 7:20 should do with our intervention, and it's not a very good indicator of prognosis. 7:24 So although this is going to add to your hypothesis and you might be able to be a 7:30 little bit more secure and saying that it's impinging syndrome using these 7:34 testing clusters, make sure that you follow up this testing with perhaps 7:40 other clusters to rule out some things like rotator cuff tears, or labral tears. 7:46 We want to make sure that there's not some other little something that's 7:51 contributing to your pain, and then we're going to have to follow this up with a 7:55 movement assessment, something like the overhead squat, goniometry, 7:58 manual muscle testing. Something that's going to give us an indication of 8:02 interventions that we can do to improve our movement, and hopefully improve our 8:07 symptoms over time. I hope you guys enjoyed this video. I hope you guys will 8:11 write down these testing clusters, start using them. If I were you I would put it 8:17 in some sort of Excel spreadsheet, or make a table and make some templates for 8:21 yourself so that you can start just checking boxes and get this into your 8:26 memory. I think if you guys start using them on a regular basis whether it be 8:30 the Park et al. which we use here, or the Michener et al. cluster it doesn't 8:36 take very long to get very efficient at using these tests in combination, and 8:42 it really doesn't take that much more time than using one test alone. I'll talk 8:45 with you guys soon. 8:54
