Name: Shoulder Special Test: Supine Shoulder Impingement Test
Uploaded: 2023-04-26T01:01:30.000Z
Duration: 9 min 4 s
Description: This video explains the Supine Shoulder Impingement Test, a physical exam procedure used in diagnosing shoulder pain. Learn what it is, how to do it, and what it can tell you about shoulder pain.

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https://stream.mux.com/gXmGITc2xf02u6WK00DMq02M2V0200MDsMqhlyDzmlAvvWJk.m3u8

This video explains the Supine Shoulder Impingement Test, a physical exam procedure used in diagnosing shoulder pain. Learn what it is, how to do it, and what it can tell you about shoulder pain.

Introduction to the Supine Impingement Test

Performing the Test: Key Techniques and Considerations

Understanding Test Results and Impingement Syndrome

Clinical Application: Treatment and Assessment Strategies

Review and Summary of the Supine Impingement Test

Shoulder Special Test: Supine Shoulder Impingement Test

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

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Special tests for shoulder impingement. The Park et al. Shoulder Impingement Testing Cluster, Hawkin's Kennedy, Infraspinatus Strength Test, Painful Arc Test, Michiner et al. Shoulder Impingement Testing Cluster, Neer's Test, Empty Can Test, Supine Impingement Test (Screening Tool). The reliability, specificity, sensitivity, validity, safety, and screening for shoulder pain, rotator cuff tears, SLAP tears, supraspinatus pathology, bicep tendon tears, shoulder impingement syndrome (SIS), labrum (labral) tears, and general arm/shoulder pathology.

Special Tests: Shoulder Impingement Syndrome (SIS)

Special tests for the rotator cuff. Shoulder Impingement Testing Cluster, Infraspinatus Strength Test, Painful Arc Test, Drop Arm Test, and the Supine Impingement Test (screening tool). The reliability, specificity, sensitivity, validity, safety, and screening for shoulder pain, rotator cuff (supraspinatus) tears, and shoulder impingement. 

Shoulder Special Test: Supine Shoulder Impingement Test

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