0:04 This is Brent of the Brookbush Institute, in 0:06 this video I'm excited to bring you 0:07 these special tests. I actually use them 0:09 here in clinic which is with these 0:11 testing clusters. In this particular 0:13 video we're going to go over the Park et 0:15 al. impingement testing cluster. I'm 0:17 going to have my friend Melissa come out, 0:18 she's going to help me demonstrate. Now 0:20 we're going to assume that I've already 0:21 done a subjective examination and 0:23 that Melissa's complaining about some 0:24 chronic shoulder pain, not necessarily 0:26 acute shoulder pain but something that's 0:28 been coming on for a little while. She's 0:30 feeling it maybe during her workouts. 0:31 We're going to do the Hawkins-Kennedy, 0:34 the infraspinatus and the painful arc 0:37 tests. So that is your Park et al. 0:40 cluster: Hawkins-Kennedy, infraspinatus, 0:43 painful arc. I'm going to go ahead and 0:46 grab her by the elbow right with that 0:47 lumbrical grip, stabilize her scapula so I 0:50 don't get upward rotation, then lay my 0:52 palm down so I have good control of her 0:53 torso, take her to 90 degrees of 0:56 horizontal adduction and flexion, give her 0:58 a little internal rotation. How does that 1:00 feel? That doesn't feel great that gives 1:03 her a little pain, is that the symptoms 1:05 you were talking about? Okay so that is 1:06 her concordant sign. Let's go ahead and 1:09 do the infraspinatus test. I'm going to 1:11 grab and stabilize her elbow, on this one I 1:13 would demonstrate first, so what we're 1:15 going to do is we're going to turn out 1:16 this way. I don't want this thing right, I 1:18 don't want you to push out against my 1:19 hand, I want you to like turn out against 1:21 my hand, I'm just gonna use this hand to 1:22 stabilize. All right so I'm going to hold 1:24 her at the elbow, apply some resistance 1:26 here at the wrist, go ahead and turn out. 1:28 How does that feel? Feels fine, that feels 1:31 fine, and she actually feels pretty 1:32 strong. She's kind of jacked, buff, (I am), 1:36 huge. No girls don't want to be huge 1:38 right. All right go ahead and stand up, 1:41 we're going to do the painful arc test. 1:44 All right remember on this one that 1:45 client patient communication is real 1:48 important, so I want you to tell me when 1:50 that pain starts, when it's at its worst, 1:53 and when it goes away, as you slowly take 1:56 your arm all the way up, okay but 1:59 sideways. 2:01 Go ahead and go up, okay no pain, no pain, 2:09 okay go ahead and sit down. So we had a 2:12 positive Hawkins-Kennedy, but a negative 2:15 infraspinatus, and a negative painful arc. 2:17 Chances are this is not impingement 2:20 syndrome. All right so now we're going to 2:22 have Melissa act this out for us in a 2:25 little different scenario, we're going to 2:27 see what her acting skills are. We're 2:29 going to do the same test but this time 2:31 we're going to pretend that you've had a 2:33 fair amount of pain, you don't remember a 2:36 specific instance, it's been getting 2:37 worse and worse during your workouts. At 2:39 this point you can't really do upper 2:41 body workouts. Nice picture, all right 2:44 good. So once again we're going to do the 2:46 Hawkins-Kennedy, go ahead and keep that 2:48 scapula stabilized, torso stabilized, 2:51 internal rotation. Pain, and that's the 2:55 symptoms you were talking about. Okay so 2:57 we got that concordance sign. All right 2:59 again I'm going to brace the elbow, brace 3:01 her wrist, she's going to push out. All 3:05 right, hard, doesn't feel good and I 3:07 actually notice this time that she has 3:09 some weakness, she's able to push against 3:11 me but she's not able to sustain it, she 3:13 kind of falls apart a little bit. Go 3:15 ahead and stand up, let's see that 3:17 painful arc. All right remember tell me 3:20 when it starts, (starts right here), okay 3:22 where is it worse, (here's at its worst). 3:24 Okay what about there, okay and then at 3:28 the top it's gone so that would be a 3:30 positive painful arc sign. Good go ahead 3:32 and sit down. So if I have those three 3:34 tests, i have positives on those three 3:36 tests we have a pretty good idea that 3:39 she is positive for impingement. Now the 3:43 Hawkins-Kennedy is probably the 3:45 strongest test of those three, but 3:48 combined the Park et al. cluster is a 3:51 much stronger diagnostic tool. The only 3:55 problem we have with impingement 3:57 syndrome is as a diagnosis it's not very 4:00 helpful to us as far as prognosis, or 4:03 predicting interventions, or deciding 4:06 what our intervention should be. So we're 4:08 still going to have to follow this 4:10 testing cluster up with maybe some 4:13 other testing clusters to rule out stuff 4:16 like labral tears, or perhaps stuff like 4:21 rotator cuff tears. We're also going to 4:23 need to follow up with a movement 4:25 assessment, maybe the overhead squat 4:26 assessment, and some gloniometry so 4:29 that we have a better idea of what 4:31 interventions could help her improve the 4:34 quality of our movement, and improve her 4:36 symptoms. So there you guys have it the Park et al. testing cluster that's going 4:42 to be Hawkins-Kennedy, infraspinatus or 4:45 resisted external rotation test, and the 4:48 painful arc test. Good diagnostic tool 4:51 for impingement, but we have to keep in the 4:53 back of our head that impingement as a 4:56 diagnosis is not particularly helpful.
