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