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This is Brent of the Brookbush Institute, and in
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this video we're going to go over two special,
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or orthopedic tests for the shoulder
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that are indicative of either
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impingement or rotator cuff damage. I'm
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going to have my friend, Melissa, come out.
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She's going to help me demonstrate these
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tests. The reason we've paired these
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tests is I think you're going to find
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they look very similar to the Kendall
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manual muscle tests we've gone over in
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previous videos. The first one is
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actually called the Internal Rotation
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Resisted Strength Test. I'm going to have
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Melissa go ahead and bring her shoulder
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into 90 degrees, her elbow in 90
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degrees of flexion, and her wrist is
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going to be in neutral. I'm going to
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brace her elbow a little bit here. I'm
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going to go ahead and put my hand behind
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her hand and have her press back into my
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hand to externally rotate the shoulder.
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I'm not going to try to overpower her. I'm
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just going to match her strength. Press
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as hard as you can, Come on, come on.
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Alight, you don't have to actually egg
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people on, but you do want to take mental
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note of how strong she is in external
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rotation. Now, I'm going to do the same in
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internal rotation. Alright, go ahead and
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press into my hand. Good. Good. And what I
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want to note is: Are they about equal? If
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internal rotation is weaker than
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external rotation, that is indicative of
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either a rotator cuff problem or
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impingement. Of course, the other sign
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that we always go back to is- go ahead
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and press in- "Does this replicate the
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symptoms you were talking about?" Always
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remember to ask that question. So,
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pain and/or weakness in internal
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rotation when compared to external
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rotation is a positive result for that
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test. Now, the other test we're going to
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do looks exactly like the manual muscle
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test for external rotation. I'm going to go ahead and
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brace her elbow hit a little bit here. I
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want to make sure I show her what I'm
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doing, what we want her to do. So, "Go ahead
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and turn your hand out this way." Because
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what you'll find is if you guys go, "Just
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press out," people tend to do that old
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school like deltoid machine thing. We
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want to test external
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rotation here. So, "Go ahead and externally
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rotate. Does that hurt? Does that provoke
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the symptoms you're talking about?"
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So, if it's pain or if I know some
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real significant weakness she may be- "Go
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ahead press out"- if she just gives way under
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a little bit of pressure, that's a
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positive sign for this test. Alright,
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guys, so, we have two tests here. We have
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the Internal Rotation Resisted Strength
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Test, and then we have the Infraspinatus,
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or External Rotation Resistance Test.
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Both of these tests can be used for
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either rotator cuffs or impingement. We
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do have to keep in mind that these
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probably should be used within testing
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clusters, because what I'm about to tell
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you is going to be a little confusing.
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These tests actually have higher
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specificity than some of the other tests
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we've already talked about, like the Neer,
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or the Hawkins Kennedy, or the Yocum, or
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even the Supine Impingement Test.
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These tests tend to be more specific
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than sensitive, which makes absolutely no
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sense to me. We have tests that-
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obviously, if they're testing for
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impingement, why are we rotating and
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testing the strength of our rotator cuff?
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So, this is already bringing in more
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diagnosis, making it a more specific test.
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Ah, fun with research. Guys, if you weren't
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confused about specificity and
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sensitivity before, you probably are now.
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That's okay, because sometimes it
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doesn't work out mathematically as it
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should. Let's start thinking through this
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logically though. Obviously, moving,
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resisting, resistance- using our strength
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in this position- for somebody with
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shoulder impingement is not going to
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feel very good. We already have
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some external rotation and some
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abduction that's probably already
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starting to compress on some of those
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subacromial tissues. In this position,
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external rotation, if somebody has pain
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in this position, they're probably pretty
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far along
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in that impingement syndrome. They're
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probably really, really inflamed. Also,
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keep in mind that if we have a rotator
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cuff tear- let's say we have a
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subscapularis tear- is this going
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to hurt? Yeah, yeah that's going to hurt a
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lot. If we have a supraspinatus or an
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infraspinatus tear, is this going to
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hurt? Sure. So, how do we differentiate
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between impingement and rotator cuff tear?
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Well, we're going to have to think about
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our subjective examination, realizing
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that ruptures and tears are usually
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acute. They usually happen with some sort
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of incident that happened rapidly.
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They're usually not chronic- not that
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they can't be. If this was a
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gradual onset, I might be thinking more
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towards impingement, whereas if this was a
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sudden onset, I might be thinking more
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towards rotator cuff, or maybe if they
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had a history of rotator cuffs. And then,
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of course, we have to start adding all of
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our other test results to this. So, if
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let's say I do some other rotator cuff
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tests and they come back negative, but I
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do a bunch of impingement tests and they
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all come back positive, then these two
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tests probably help us solidify our
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impingement hypothesis, as opposed to
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solidify a rotator cuff hypothesis. Now,
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how would I use this? Of course, I would
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use this within a testing cluster, and I
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would be looking for the concordant
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sign, which I keep talking to you guys
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about. You want to find your quick tests.
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We're all short on time. So, as you're
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going through your tests and find the one that
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immediately provokes their symptoms, man,
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you want to make note of that, because
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when they come to the next time, that's
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the one you're going to go back to. You're
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not going to go through your whole
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battery of tests again. You're going to
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go back to that one provocative test, and
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then that's the one you're going to keep
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going back to as you test different
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interventions. So, maybe I want to release
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a few things and then see how that works,
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test my hypothesis. Maybe I then want
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to activate a few things, test my
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hypothesis. Maybe I want to try something a
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little bit more outside of the box,
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although I know us movement
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professionals think in this way. Maybe I
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want to try some thoracic spine
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mobilization or manipulation, thinking
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that maybe scapular dyskinesis is
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contributing to shoulder instability and
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see if that improves. Well, I now have-
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let's say this is her concordant sign-
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I now have a quick test that I can
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keep coming back to after each
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intervention. We are going to be talking
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about those testing clusters in
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future videos. Please stay tuned. Let me
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give you guys a quick review here of
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these two tests. I hope you guys will
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keep watching. So, starting with the
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Internal Rotation Resistance Test: I'm
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going to go ahead and bring her arm up
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to 90 degrees of abduction, elbow 90
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degrees of flexion, and wrist neutral. The big
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sign on this test is internal rotation
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weaker than external rotation. That
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should make sense to you guys from a
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kinesiology standpoint. Your internal
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rotators are much bigger and stronger. So,
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if your internal rotation rotators are
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testing weaker than your external
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rotators, that's an issue. We go ahead and
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test external rotation first. Alright,
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that feels pretty strong. We test internal
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rotation. That's also pretty strong, so that's a
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negative test, unless it happened to- "Did
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that provoke your symptoms?" Oh, it did
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provoke her symptoms. Well, then that's a
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positive, actually. That's still a
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positive test. I want to remember
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that for my future quick tests. Again, the
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External Rotation Test looks exactly
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like that Kendall MMT. I'm going to go
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ahead and brace her elbow here a
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little bit, hold her elbow and make sure she's
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not doing the old-school deltoid
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exercise here. Go ahead and press out
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in external rotation. She's very, very
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strong, so I'm not getting any indication
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there. "Does that provoke your symptoms?"
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Yes, oh, that provokes her symptoms, so we
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have some some serious issues here
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having to do with either impingement or
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rotator cuff, and I need to continue
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testing. Guys, I hope you will continue to
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learn your assessments. If you're not
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assessing, your guessing. Step up your
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assessment game
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and continue watching these videos