This is Brent of The Brookbush Institute
and in this video we're going to go over the
special or orthopedic test known as the
Painful Arc Test. This is part of our
shoulder evaluation for impingement syndrome.
I'm going to have my friend Melissa
come out, she's going to help me demonstrate.
Now, we're going to pretend
for a second that you're having pain in your right shoulder.
What I'm going to have you do is I'm going to
have you go ahead and raise your arm up
like this. Good. Did that hurt?
From here we want to try to get a little
bit more out of Melissa because just
saying "this hurt" is good, but a
positive Painful Arc test is actually
pain between 60 and 120 degrees of
abduction, and then a decrease or absence
of pain at the top. So what I want you to
do is slowly raise your arm this time. I
want you to tell me where the pain
starts, where it's at its worst, and if it
gets better as you start moving further
and further into (this is called)
abduction. Go ahead and try that for me.
So, pain started there.
Okay. What about there?
So, that would be a very common finding for a
positive painful arc, that they have
pain starting about here it gets worse,
and worse, and worse,
and then all of a sudden, as they get up
in here, it gets better again. Now, just as
we've talked about with all of these tests,
this is not a particularly sensitive or
specific test, as many of our impingement
tests aren't. This is a test that we
use in a whole lot of clusters and I
think it's because it's one of those
subjective findings we hear from
patients a lot. They talk about " it
hurts when I'm raising my arm, but then
when my arm is up here it doesn't hurt
as much. I've just got to get through this
part here and then I'm okay."
That's a great subjective finding,
can definitely work on, but as it goes
for the research side of this,
specificity and sensitivity is fairly
low. With all of these impingement tests
we tend to cluster them, and
unfortunately, despite this not being a
great test, it is found in all of the
impingement testing clusters.
So, how would I use this test in a cluster?
And, of course, is this their
concordant sign? Is this the one test that I can
keep coming back to, that "boom", there's
their symptoms and I can use it as a pre
and post-test in between interventions?
I want to show you guys what this looks
like from the front again.
Once again Melissa, we're going to go
ahead and have you raised this arm. I
want you to tell me when it starts
hurting, when the pain is at its worst,
and when it starts dissipating or
Okay, maybe a little simplified I'm sure you guys can
get a little bit more information out of your patients,
but Melissa here does not have
impingement on her right side. Once again
guys, step up your assessment game.
It really is going to be what makes you a
marquis professional. The more tests you
have, the more clusters of tests you
bring in, the stronger your hypothesis,
and if you can get a strong hypothesis
together, that's where you can start
building some very sophisticated
I'll talk with you guys soon.