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Rotator Cuff Impingement Tests

The document discusses various conditions that can cause shoulder pain including rotator cuff injuries, impingement, tendinitis, tears, biceps tendonopathies, and adhesive capsulitis. It describes the anatomy and innervation of the rotator cuff muscles and provides details on clinical exams like Neer's test, Hawkins' test, and Spurling's maneuver to evaluate patients with shoulder pain.

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Farwa
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89 views29 pages

Rotator Cuff Impingement Tests

The document discusses various conditions that can cause shoulder pain including rotator cuff injuries, impingement, tendinitis, tears, biceps tendonopathies, and adhesive capsulitis. It describes the anatomy and innervation of the rotator cuff muscles and provides details on clinical exams like Neer's test, Hawkins' test, and Spurling's maneuver to evaluate patients with shoulder pain.

Uploaded by

Farwa
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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SHOULDER REGION

BY
DR KINZA ANWAR
DPT,MSOMPT
Rotator Cuff
Made up of:
MUSCLES •SS
•IF
•Sub scap
•Teres minor

Other stabilisers
•Upper, Middle and Lower
traps
•Post Deltoid

Other muscles that impact on


shoulder Position:
•Rhomboids
•Pec Minor
INNERVATION OF THE RC
Supraspinatus: suprascapula nerve C4, C5, C6

Infraspinatus: suprascapula nerve C5, C6

Subscapularis: Upper and lower subscapular nerve C5,


C6, C7

Teres Minor: Axillary nerve C5, C6


THE ROTATOR CUFF
MUSCLES: SITS
Supraspinatus ABD Teres minor ER
Infraspinatus ER Supscapularis IR

Depress humeral head against glenoid to allow full abduction


REFERRED SHOULDER PAIN

• Mutisegmental innervation…C3-C5 same for shoulder and


diaphragm
Diaphragmatic irritation:
 Irritation from central part diaphragm dome refers sharp pain to the
ipsilateral upper trapezius, neck and/or supraclavicular fossa and
posterior portions of the shoulder.
ROTATOR CUFF
IMPINGEMENT/TENDINITIS
Rotator cuff muscles, (especially
supraspinatus) & biceps tendon
Impinge against undersurface
of acromion & coracoacromial
ligament
ROTATOR CUFF
IMPINGEMENT/TENDINITIS
Mechanism:
Subacromial bursa & rotator
cuff tendon become inflamed
secondary to friction against
undersurface of acromion &
coracoacromial ligament
May result from overuse, rotator
cuff weakness, mild anterior
instability, direct trauma
ROTATOR CUFF
IMPINGEMENT/TENDINITIS
Predisposing factors:
 Repetitive motion of shoulder above horizontal plane
(swimming, throwing, golf, tennis, etc.)
 Fatigue of rotator cuff  abnormal shoulder mechanics
 Subtle instability resulting in 2° impingement
 AC joint spurring/hypertrophy
ROTATOR CUFF
IMPINGEMENT/TENDINITIS
History:
 Pain referred to anterolateral aspect of shoulder w/ some radiation
(not beyond elbow)
 Aggravated w/ overhead activities
 Night pain
 Clicking or popping sensation
ROTATOR CUFF
IMPINGEMENT/TENDINITIS
Physical Exam:
 Possible atrophy of supra- & infraspinatus

 Tenderness over greater tuberosity & long head of biceps

  range of motion

 Painful arc within 70° to 120° abduction


FINALLY…THE
SUBACROMIAL SPACE
WHAT CAN GO WRONG???

Impingement!!!!!!!
IMPINGEMENT
ROTATOR CUFF
IMPINGEMENT/TENDINITIS
Treatment:
Conservative
Temporary avoidance of
aggravating factors
Ice
NSAIDS
Corticosteroid injection
Physical Therapy
IMPINGEMENT SIGNS:
NEER’S TEST
Scapula stabilized
Arm fully pronated
Examiner brings
shoulder into maximal
forward flexion
Pain  subacromial
impingement
IMPINGEMENT SIGNS:
HAWKINS’ TEST
Patient’s arm forward
flexed to 90°
Elbow flexed to 90°
Shoulder forcibly
internally rotated by
examiner
Pain  subacromial
impingement or
rotator cuff tendinitis
ROTATOR CUFF TEAR
Supraspinatus tendon most common

Acute trauma or chronic tendinopathy

Treatment dependent upon age/activity


 Young, active usually require operative treatment
 Older, low-activity usually respond to non-operative
treatment
ROTATOR CUFF SIGN:
DROP ARM TEST
Passively abduct patient’s
shoulder
Observe as patient slowly
lowers arm to waist
If arm drops to patient’s side,
suggests rotator cuff tear &/or
supraspinatus dysfunction
BICEPS TENDONOPATHY
Speed Test

Yergason Test
Direct palpation
BICEPS TENDONOPATHIES
Repetitive overhead activity

Repetitive forearm
flexion/supination

Difficult to discern from rotator


cuff tendinopathy or
impingement
BICEPS TENDON:
SPEED’S TEST
Elbow flexed 20°-30°
Forearm supinated
Arm in 60° flexion
Patient forward flexes arm
against examiner’s
resistance
PHYSICAL EXAM
STRENGTH OF SUBSCAPULARIS

Liftoff test Belly press test


ADHESIVE CAPSULITIS

“Frozen shoulder”
Thickening & contraction of capsule around
glenohumeral joint causing loss of motion & pain
Mechanism:
Unknown
Possibly 2° to pain & guarding of shoulder
Other: Trauma, rotator cuff tendinitis, RSD,
CAD, DM, hormonal imbalance
ADHESIVE CAPSULITIS

History:
Slow onset of shoulder pain (pain  as motion
progressively )
Limited range of motion
Night pain
ADHESIVE CAPSULITIS
Physical Exam:
 Significant  range of motion
 Internal & external motion most limited
Radiographs:
 Routine x-rays usually normal
ADHESIVE CAPSULITIS

Treatment:
Physical therapy:
Work on gentle range of motion
NSAIDS
Ice
Corticosteroid injections
Manipulation under anesthesia
SHOULDER PAIN ISN’T
ALWAYS THE SHOULDER!!
GET MORE HISTORY…

Gall bladder disease


Peptic Ulcer Disease
Cervical radiculopathy
Cardiac ischemia
Pulmonary conditions
CERVICAL SPINE:
SPURLING’S MANEUVER
Neck extended
Head rotated toward
affected shoulder
Axial load placed on the
spine
Reproduction of patient’s
shoulder/arm pain
indicate possible nerve
root compression
THANKS

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