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