ASSESSMENT AND DIAGNOSIS

TABLE 2: TABLE OF TESTS TO AID DIAGNOSIS Supraspinatus (full can test)

General tests Recent studies have shown that sub- scapularis and infraspina- tus are active during abduction as much as supraspinatus (18). Differential tests may be useful in providing more specificity to diagnosis.

Infraspinatus Subscapularis

Resisted abduction at 90º with thumb pointing upwards - this has recently demonstrated more accuracy in specifically testing supraspinatus than the empty can test

Resisted lateral rotation from a 45º medially rotated position (this has been shown to min- imise co-activation of posteri- or deltoid and supraspinatus)

(‘Gerber Push With Force’ test) Sitting with dorsum of hand resting against small of back at waist level. The patient is asked to lift the hand poste- riorly off the back against tester’s resistance (2).

Impingement tests Neer’s test In two parts:

Hawkins-Kennedy test Painful arc test Speed test

The patients scapula and clavicle are stabilised, pre- venting movement, whilst the arm is forcibly fully flexed. Pain will be elicited if SIS is implicated. A posi- tive result is concluded if on injecting local anaesthetic and retesting the pain disappears.

slowing of the analysis.

SUMMARY SIS is a complex and most likely a multi- factorial condition, which can occur at any age and to anyone. Its prevalence in sport is highlighted by the fact that it accounts for 11% of all orthopaedic injuries (20). For the past two years statistics have shown it to be the third most common pre- sentation in my clinic, numbers only being superseded by low back pain and anterior knee pain. Accurate and comprehensive assessment will enable an effective treat- ment plan to be devised.

The Author

Jo Burgess Bsc (Hons), MCSP graduated as a chartered physiotherapist in 1996 from

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The patient’s arm is forward flexed to 90º with 90º elbow flexion. The arm is then forcibly medially rotated. A positive test reproduces pain, indicating supraspinatus ten- don has been impaled under the coracoacromial ligament.

The patient is asked to actively elevate the arm into abduction following the plane of the scapula and subsequently lower the arm in the same plane. A positive test results in pain occurring between 60-90º of both movements.

With the patients elbow fully extended and forearm supinated, the shoulder

is

actively flexed whilst resis- tance is applied. A positive test is the presence of pain in the location of the bicip- ital groove implicating long head of biceps.

Keele University. After 6 years working in the NHS she has spent the last 4 years work- ing for the Royal Air Force at the Primary Care Rehabilitation Facility (PCRF) RAF Wittering, treating a variety of patients and conditions, including fast jet Harrier pilots and elite level sports men/women. She is a Stott certified Pilates instructor and a mem- ber of the Society of Orthopaedic Medicine. She is currently completing a diploma in injection therapy. This year (as last year) she will be working voluntarily at the London Marathon.

References 1. Lewis SJ, Green A, Dekel S. The aetiology of subacromial impingement syndrome. Physiotherapy 2001;87:458-469 2. Hanchard N, Cummins J, Jeffries C. Evidence

-based clinical guidelines for the diagnosis assessment and physiotherapy management of shoulder impingement syndrome. Chartered Society of Physiotherapy 2004. London, UK 3. Lintner SA, Kenter K, Speer KP. Glenohumeral translation in asymptomatic athlete’s shoulder and it’s relationship to other clinically measur- able anthropometric variables. American jour- nal of Sports Medicine 1996;24(6) 4. Neer C,.Welsh RP. The shoulder in sports. Orthopaedic Clinics of north America 1977;8,3:583-591 5. Dickens VA, Williams JL, Bharma MS. Role of physiotherapy in the treatment of subacromial impingement syndrome: a prospective study. Physiotherapy 1994;91(3):159-164 6. Brox et al. Arthroscopic surgery versus super- vised exercises in patients with rotator cuff dis- ease (stage II impingement syndrome): a prospective, randomised, controlled study in 125 patients with a 2 year follow up. Journal of Shoulder and Elbow Surgery 1999; 8:111-120 7. Kesson M, Atkins E. Orthopaedic Medicine: a

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