0:04 This is Brent of the Brookbush Institute, and 0:05 in this video we're going to go over the 0:07 Park et al. rotator cuff tear testing 0:10 cluster. I'm excited to bring you guys 0:12 this video because it finally brings 0:13 together all of the special test videos 0:15 we've done, into the clusters we actually 0:19 use in clinic. I'm gonna have my friend 0:21 Alyssa come out she's going to help me 0:22 demonstrate this testing cluster. Now 0:24 this cluster is three tests, we're going 0:27 to do the external rotators strength 0:29 test the infraspinatus test. We're 0:31 going to do the drop arm test, and we're 0:33 going to do the painful arc test. If she 0:35 gets a positive and all three of those 0:36 tests,. chances are we have rotator cuff 0:41 tear. Now if we were talking to somebody 0:43 other than Alyssa, her being over 60 0:46 years of age, would also be another 0:48 positive sign that we could add to our 0:51 diagnostic criteria. So I'm 0:53 going to go through these three tests 0:55 real quick here. First we're going to 0:56 start off with that infraspinatus test 0:59 or the external rotators strength test. 1:00 Once again I would demonstrate this, make 1:02 sure you're turning out you're not 1:04 pushing out with your shoulder alright 1:06 so I'll brace your elbow, go ahead and 1:08 brace your wrist like this, go ahead and 1:10 push out. How's that feel? Feels 1:13 pretty strong, she has no pain. 1:16 We're going to go ahead and have her 1:17 stand up. Now the drop arm test normally 1:21 you would be in front of your patient, 1:22 you're going to go ahead and passively 1:24 take them to 90 degrees of shoulder 1:28 abduction. I'm going to go ahead and have 1:29 her hold this for me, can you hold up 1:31 here. Now if I let go, and let's say this 1:35 is her symptomatic side, and all of a 1:36 sudden she dropped, she couldn't even 1:38 hold it up here, that would be a positive 1:40 sign, The other thing you guys will see 1:42 is if I let her go and she slowly brings 1:45 her arms back down, and we saw one side 1:48 fall faster than the other, despite the 1:50 fact that she was trying to bring them 1:52 down equally, that would also be a 1:54 positive sign on this test. Now the last 1:57 one we've done a few times both in the 1:59 clusters and as an end of 2:01 video here, we have the painful arc test, 2:04 this one again patient communication is 2:07 very important. You want to make sure 2:09 they tell you when the pain starts, when 2:11 it's at its worst, and then when it goes 2:14 away as they take their shoulder through 2:16 its entire range of motion of abduction. 2:19 So she's going to come out in this big sweeping 2:20 motion as high as she can, and in 2:25 Alyssa's case, anything? No pain. 2:28 Alright so go ahead and have a seat. She 2:32 obviously was negatived all that these 2:34 three tests, so we're going to say 2:35 rotator cuff probably not torn, your 2:38 rotator cuff is probably fine. now let's 2:42 test your acting skills. We're going to 2:44 say Alyssa's a swimmer, except instead of 2:47 the impingement video we did where we 2:49 talked about a chronic onset, we're going to 2:52 say this time she's coming in three 2:54 weeks after having a spill at the pool. 2:56 She was trying to walk around the pool, 2:58 hit a wet spot, feet went out from under her. 3:01 You guys know what that's like 3:02 especially if you live here in New York 3:04 in a winter. You hit a piece of snow, 3:06 something, feet fly out. She put her arm 3:09 back to block herself, and as she did her 3:13 shoulder gave out. That caused instant pain, 3:16 she hasn't swam since, the pain has been 3:20 getting progressively worse and she's 3:22 known as she's gotten a lot weaker and 3:23 has pain during some functional 3:25 activities, maybe just raising up her arm 3:28 to take a glass out of the top shelf of 3:31 a cupboard. So that would be a 3:32 kind of a standard subjective exam that 3:34 we would get back for somebody who's 3:36 indicative of rotator cuff tear. Now 3:38 we're going to do these tests again, 3:40 we're gonna get a little acting from you, 3:42 you ready? So we maybe go ahead and 3:44 do that infraspinatus test, I brace her 3:47 elbow, I say go ahead and try to push out, 3:49 and all I see is like marked weakness 3:51 right off the bat, and I wouldn't be 3:53 surprised does that hurt. It does. Alright so 3:55 that hurts, that's not good that's 3:58 one positive. Go ahead and stand up for 4:00 me. 4:02 If I take her to 90 degrees here and I 4:06 go ahead and ask her to hold this for me, 4:09 and then slowly let her arms back down 4:10 to her side, and we noticed we already 4:13 have a problem or she's having a hard 4:15 time holding this side up. Did that hurt 4:16 just to try to keep it up? Okay, and if I 4:19 ask you to try to pull your arm up this 4:22 way, can you do it? You can, notice she's 4:26 kind of focused on this side here, how did 4:30 that feel is that painful, yeah, okay. 4:33 So let's do this one more time 4:35 we'll just do this arm okay, and let me 4:39 have you try to go up, where does the 4:40 pain start? Right about there, okay, so she 4:43 has pain right about there, probably 4:45 worse right up here. Yeah, and it wouldn't 4:51 be surprising to me guys if you ask 4:53 somebody to do this painful arc test, and 4:55 they can barely do it because of pain if 4:58 we had a rotator cuff tear. Good, go ahead 5:01 and take a seat for me. Alright, so she 5:04 has positive to all three of those tests 5:06 we have a pretty good indication that we 5:10 have a rotator cuff tear, and unlike our 5:12 impingement syndrome where that gives us 5:15 poor prognosis, poor diagnostic info; in 5:20 this case rotator cuff tears are 5:23 something human movement professionals 5:25 whether we're athletic therapists, we're 5:28 physical therapists, we're chiropractors 5:30 we have to be a little careful with. If 5:32 we see really really marked weakness on 5:36 all of these exams, a whole lot of pain, 5:40 we might want to go ahead and refer out 5:43 to a physician, get some imaging done. 5:45 Because we know that those significant 5:48 tears, those significant rotator cuff 5:50 tears, don't often do very well with 5:53 physical therapy. We don't want to waste 5:55 our clients time, wasted our clients 5:57 resources and money trying to apply 6:00 physical therapy modalities that in the 6:04 long run are probably not going to work 6:06 anyway. This is also one of those 6:09 diagnostic criteria's where we have 6:13 to be very careful with the 6:14 interventions we 6:15 select, because we don't want to select 6:17 interventions that could make that tear 6:19 worse. So whereas I might give somebody 6:22 let's say external rotation activation 6:24 to start with, and I might grab let's say 6:28 a blue band which is the second or third 6:31 strength up, maybe for her I'm just going 6:33 to go okay, can we get a little external 6:36 rotation done. If we can i'm going to 6:38 start off with a really light band to 6:41 start strengthening and maybe i don't 6:42 even want to start with those 6:43 strengthening activation techniques, I 6:45 start with some mobility techniques. See 6:48 if increasing mobility, reducing some of 6:51 the hyperactivity that comes with a 6:52 rupture or comes with in acute injury 6:55 like that, helps to improve symptoms. If 6:57 it does then we continue on with our 6:59 therapy and see if we can do this 7:01 conservatively rather than 7:03 surgically. So there you guys have it the 7:05 Park et al rotator cuff testing cluster. 7:10 That was the external rotation strength 7:12 or infraspinatus test, the drop arm test, 7:16 and the painful arc test. Definitely one 7:19 of the testing clusters we use here, 7:21 along with that Park et al. impingement 7:24 test when we have individuals who come 7:27 in with shoulder pain. 7:36 you
