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Park et al. Subacromial Impingement Testing Cluster
The Park et al. Subacromial Impingement Testing Cluster is a comprehensive testing system designed to accurately diagnose, and quantify, the presence of shoulder subacromial impingement. It involves a series of shoulder assessments that measure shoulder motion, strength, neuromotor control, function, and pain, incorporating both standard and novel metrics to provide a comprehensive evaluation of shoulder health. The testing cluster has been validated by several research studies, and is an invaluable tool for diagnosing imp
Transcript
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This is Brent of the Brookbush Institute, in
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...blank
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this video I'm excited to bring you
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these special tests. I actually use them
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here in clinic which is with these
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testing clusters. In this particular
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video we're going to go over the Park et
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al. impingement testing cluster. I'm
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going to have my friend Melissa come out,
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she's going to help me demonstrate. Now
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we're going to assume that I've already
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done a subjective examination and
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that Melissa's complaining about some
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chronic shoulder pain, not necessarily
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acute shoulder pain but something that's
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been coming on for a little while. She's
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feeling it maybe during her workouts.
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We're going to do the Hawkins-Kennedy,
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the infraspinatus and the painful arc
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tests. So that is your Park et al.
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cluster: Hawkins-Kennedy, infraspinatus,
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painful arc. I'm going to go ahead and
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grab her by the elbow right with that
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lumbrical grip, stabilize her scapula so I
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don't get upward rotation, then lay my
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palm down so I have good control of her
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torso, take her to 90 degrees of
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horizontal adduction and flexion, give her
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a little internal rotation. How does that
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feel? That doesn't feel great that gives
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her a little pain, is that the symptoms
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you were talking about? Okay so that is
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her concordant sign. Let's go ahead and
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do the infraspinatus test. I'm going to
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grab and stabilize her elbow, on this one I
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would demonstrate first, so what we're
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going to do is we're going to turn out
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this way. I don't want this thing right, I
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don't want you to push out against my
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hand, I want you to like turn out against
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my hand, I'm just gonna use this hand to
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stabilize. All right so I'm going to hold
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her at the elbow, apply some resistance
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here at the wrist, go ahead and turn out.
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How does that feel? Feels fine, that feels
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fine, and she actually feels pretty
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strong. She's kind of jacked, buff, (I am),
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huge. No girls don't want to be huge
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right. All right go ahead and stand up,
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we're going to do the painful arc test.
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All right remember on this one that
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client patient communication is real
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important, so I want you to tell me when
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that pain starts, when it's at its worst,
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and when it goes away, as you slowly take
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your arm all the way up, okay but
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sideways.
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Go ahead and go up, okay no pain, no pain,
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okay go ahead and sit down. So we had a
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positive Hawkins-Kennedy, but a negative
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infraspinatus, and a negative painful arc.
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Chances are this is not impingement
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syndrome. All right so now we're going to
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have Melissa act this out for us in a
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little different scenario, we're going to
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see what her acting skills are. We're
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going to do the same test but this time
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we're going to pretend that you've had a
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fair amount of pain, you don't remember a
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specific instance, it's been getting
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worse and worse during your workouts. At
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this point you can't really do upper
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body workouts. Nice picture, all right
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good. So once again we're going to do the
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Hawkins-Kennedy, go ahead and keep that
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scapula stabilized, torso stabilized,
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internal rotation. Pain, and that's the
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symptoms you were talking about. Okay so
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we got that concordance sign. All right
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again I'm going to brace the elbow, brace
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her wrist, she's going to push out. All
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right, hard, doesn't feel good and I
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actually notice this time that she has
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some weakness, she's able to push against
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me but she's not able to sustain it, she
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kind of falls apart a little bit. Go
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ahead and stand up, let's see that
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painful arc. All right remember tell me
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when it starts, (starts right here), okay
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where is it worse, (here's at its worst).
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Okay what about there, okay and then at
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the top it's gone so that would be a
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positive painful arc sign. Good go ahead
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and sit down. So if I have those three
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tests, i have positives on those three
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tests we have a pretty good idea that
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she is positive for impingement. Now the
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Hawkins-Kennedy is probably the
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strongest test of those three, but
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combined the Park et al. cluster is a
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much stronger diagnostic tool. The only
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problem we have with impingement
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syndrome is as a diagnosis it's not very
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helpful to us as far as prognosis, or
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predicting interventions, or deciding
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what our intervention should be. So we're
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still going to have to follow this
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testing cluster up with maybe some
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other testing clusters to rule out stuff
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like labral tears, or perhaps stuff like
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rotator cuff tears. We're also going to
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need to follow up with a movement
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assessment, maybe the overhead squat
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assessment, and some gloniometry so
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that we have a better idea of what
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interventions could help her improve the
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quality of our movement, and improve her
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symptoms. So there you guys have it the Park et al. testing cluster that's going
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to be Hawkins-Kennedy, infraspinatus or
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resisted external rotation test, and the
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painful arc test. Good diagnostic tool
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for impingement, but we have to keep in the
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back of our head that impingement as a
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