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Shoulder Special Test: Supine Shoulder Impingement Test
The Supine Shoulder Impingement Test is used to assess Strength and Pain within the Shoulder Joint. This test is performed with the client in the prone position with their arm in 90° abduction and their elbow in 90° flexion. The examiner will then apply an upward pressure to the arm and ask the client to maintain the pressure while turning their thumb up. If there is pain or weakness at the end of the reposition it is suggestive of an impingement.
Transcript
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This is Brent, President of the Brookbush
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...blank
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Institute, and we're going over the
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Supine Impingement Test, one of our
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special orthopaedic tests used during
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shoulder examination. I'm going to have my
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friend, Melissa, come out. She's going to
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help me demonstrate. Now, this is the
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supine test, so I'm going to have her lay
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down on her back. This is not a
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complicated test. Although, if you're
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reading the instructions for the first
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time or listening to me tell you the
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instructions for the first time, there is
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a little trick at the end that may catch
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you if you're not paying attention. So,
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what we want to start with is taking
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Melissa's elbow and wrist and we're
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going to take her arm all the way into
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flexion with the arm externally rotated,
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just past neutral. As I get her all the
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way down to flexion, I'm going to push
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her into abduction, which is closer to
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her ear, and then I'm going to internally
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rotate. As I internally rotate, I can ask
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her, "Does that replicate your symptoms?"
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She said, "No," so that would be a
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negative, or a sign that maybe she
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doesn't have impingement syndrome. Now, I
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told you there was one thing during that
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little set of instructions that might
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mess you up, and that's the fact that as
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we get all the way into flexion, our
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directions for external and internal
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rotation get reversed. So, rolling out
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down here would be external rotation,
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rolling out up here would be internal
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rotation. If I- that's all internal
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rotation. So, watch how I perform this
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test again. All the way into flexion with
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the thumb kind of going in the direction
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that we're going, and then as I get her
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up here, I push her into a little bit of
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abduction, really taking her all the way
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to that end range. And then to internally
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rotate, I have to turn her back this way.
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And, of course, I ask that question, "Is
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that what you were complaining about?"
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Okay.
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I'm going to show you guys on the other
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side, just in case that gives you a
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little better view. So, I take her wrist
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and elbow all the way into flexion. If I
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push her closer to her ear, that would be
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abduction. Really take her all the way
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into her end range. And then I'm going to
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roll back this way into internal
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rotation and ask that question, "Does that
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replicate the pain you were talking
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about?" Okay, and it doesn't replicate the
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pain, so at this point this is a negative
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test. Now, what's the intent of this test,
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right, is to try to provoke those
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impingement symptoms. You can kind of
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think about the anatomy here. As I take
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her all the way into her end range, and then at
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end range internally rotate her shoulder,
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I'm probably taking those tubercles,
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the greater and lesser tubercle of
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the humerus, and just running it across
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the underside of the acromion shelf. And,
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of course, that has the potential to
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irritate tissues that
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are already inflamed. This test does have
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a higher sensitivity rating than our
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Neer Test, which we've talked about
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before. It's a pretty bad test. Neer is an
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important test for you to know, because
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it's going to be part of our impingement
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cluster that I'll teach later. But this test,
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if we're going to do one test for
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impingement, this would be a better selection.
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Keep in mind, if I'm doing one of
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these tests, I'm never going to take a
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test like this at face value. Just
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because she said this doesn't
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replicate her symptoms, it doesn't quite
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mean she doesn't have impingement syndrome
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yet. There could be another test that I
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get a positive on, for example, Hawkins
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Kennedy or the Neer, which we already
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talked about. Also keep in mind that the
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specificity of all of our impingement
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tests overall is pretty low. We
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talked a little bit about that in the
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Neer Test, which was that
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soon as something goes wrong with the
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shoulder, we get some inflammation, we
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decrease that subacromial space a bit, it
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probably irritates tissues, then pushing
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somebody to end range, regardless of
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whether it's a labral tear, whether it's
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a rotator cuff tear, whether it's biceps
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tendinitis, supraspinatus tenditis, it
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almost doesn't matter at this point. This
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is going to hurt. Right? So, we have very
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low specificity on these tests. Now, if
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she came in and she complained about
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anterior shoulder pain with a gradual
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onset, so I'm not thinking acute things
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like tears and ruptures and labral stuff,
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and then I did my movement assessment and
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she had some upper body signs.
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Maybe she had arms fall forward, elevation of
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her scapula during that overhead squat
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assessment, and when I put her hands down on
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the overhead squat assessment with
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modification, she collapsed forward. I'm
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thinking, okay, gradual onset, upper body
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mechanics don't look great, maybe we got
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a positive test on this and a couple
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other tests. Does this point to any
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specific impairment? Well, as I'm going
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through this, I'm not going to totally
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turn off and only think about this test.
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Did flexion feel normal? Did internal
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rotation feel normal? Did external
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rotation feel normal? Does this lead me
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towards maybe wanting to do some goniometry
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or something else that might give
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me an indication of some movement
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impairment that I could correct that's
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going to help her symptoms. Of course, is
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this her concordant sign? Is this
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the test, which it wasn't in
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this case because you told me no, could
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I use this as a pre- post-test if this
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Was the test that set off her symptoms?
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We're always looking for those quick
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test, guys. From a practice standpoint, you
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need to find that thing that replicates
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their pain, because that's going to be a
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learning tool for you. Right? So, if I did
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this- say yes this time- if I did this, did
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this test, and asked, "Does this replicate your
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symptoms?"
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Yes. Well, good, now I have an easy test to
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keep coming back to. Let's say I did that
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at the beginning of a session and I go,
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"Okay, here's what we're going to do. I'm
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going to try releasing your
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subscapularis. I'm going to try releasing
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your pectoralis minor. And I'm going to
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try a little posterior shoulder
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mobilization, and we'll see if that helps your
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shoulder out. Last time we did two of
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those- subscapularis and pectoralis minor
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release. This time I'm going to add that
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mobilization. I want to see if it gets us
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a little further." I do my manual
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techniques and go, "Okay, does that feel
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better?" Yes. If she says yes, then good, I
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have one more box that I can check off,
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one more intervention that I know worked.
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If she said no, okay, we won't do that
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intervention. That was not the
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intervention we were looking for. It's
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important that you have a quick test to
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come back to if you're going to continue
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refining your treatment program as you
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go along. Now, of course, guys, keep in mind
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that if this was a positive test and I
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continue to do treatment and nothing is
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working, that's a good sign that maybe
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you have to refer out. As we said, these
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tests have a very low specificity, all of
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our impingement tests. So just because I
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got pain, if I'm a confident therapist
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and I've been doing this a while, and I
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know or I kind of have a prognosis in my
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head of how quickly things should work,
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and after three, four, five, six sessions
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I'm not really seeing change, a positive
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impingement test just means I got pain
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during shoulder flexion, and in this case
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shoulder flexion with internal rotation.
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It doesn't necessarily rule out structural
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changes, like maybe a rotator cuff tear in
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this case, maybe a subacromial bone spur,
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maybe things have just gotten so
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inflamed that we need some other medical
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management such as some
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anti-inflammatories or an injection. So,
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there you guys have it. Here's a quick review of
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this test: thumb up, hold elbow and wrist, go all
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the way into shoulder flexion, push all
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the way into abduction, closer to the ear,
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and then you're going to roll that
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humorous back towards you, and ask that
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question, "Is that the symptoms you were
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talking about?" Yes. We started off as
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a no and now it's a yes, maybe it's
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because this is not the first take
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and I'm just starting to aggravate her
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shoulder. I hope you guys learned a
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lot in this video. I look forward to
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hearing from you.
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