SHOULDER IMPINGEMENT

Note: Although these are widely used and respected tests, care should be taken in the interpretation of results. Recent studies have doubt- ed their reliability in detecting SIS. SLAP lesions, posterior superior glenoid impingement (PSGI) and minor instability will also give positive impingement test results (2).

The Scarf test, commonly used to test compression of the AC joint should be tested at this point, but recent studies have also shown it to give positive results for impingement (19).

Instability tests Instability can be classified into 3 types: ■ Anterior instability - resulting from repeated micro trauma to the anterior capsule ■ Multi-directional instability - due to generalised musculoskeletal laxity ■ Posterior instability - rare

Load and shift manoeuvre Anterior apprehension test

Relocation test for anterior instability Perform the anterior apprehen- sion test. When the limit to available range is reached apply a posterior directed pressure to the humeral head. A positive test results in diminished pain or reduced apprehension .

Patient sitting with hand on thigh. Tester stabilises the clav- icle and scapula with one hand whilst cupping the humeral head with the other hand. The humer- al head is then gently com- pressed medially against the gle- noid. Maintaining

compression

the humeral head is then moved anteriorly and posterorly. The test is positive for anterior instability if >25% of the humer- al head diameter is moved ante- riorly. Multidirectional instability is diagnosed if the test is positive in both directions.

In supine lying, the patient’s shoulder is slowly moved into 90º abduction and full external rotation. A positive test results when the patient is reluctant or apprehensive to move into this position as the joint feels like it will subluxate, or reports pain.

Sulcus test

With the patient in sitting, downward traction is applied through the humerus whilst sta- bilising the scapula. A positive test for multidirectional instabil- ity reveals a gap (sulcus) appearing between the acromion and humeral head.

practical approach. Butterworth Heinemann 1998. ISBN 0750625430 8. Corrigan B, Maitland GD. Practical Orthopaedic Medicine. Butterworth Heinemann 1983. ISBN 0750604948 9. Margery M, Jones M. Clinical diagnosis and management of minor shoulder instability. Australian Physiotherapy 1992;38(4):269-280 10. Liu SH et al. Diagnosis of glenoid labral tears: a comparison between magnetic reso- nance imaging and clinical examinations. American Journal of Sports Medicine 1996;24,2:149-154 11. Fukada H et al. Partial thickness tears of the rotator cuff: a clinic pathological view based on 66 surgically verified cases. International Orthopaedics 1996;20:257-265 12. Hutchinson M. The challenge for science in manual/musculoskeletal medicine: in support of pragmatism. The Journal of Orthopaedic Medicine 2005;27(3):152-154 13. Reilly BM. “The Essence of EBM-practising

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what we teach remains a big challenge”. BMJ 2004;329:992-992 14. Cyriax JH. Textbook of Orthopaedic Medicine, Volume 1: Diagnosis of Soft Tissue Lesions 1982. Balliere Tindall. 8th Edition 15. McClure PW et al. Direct 3-dimensional mea- surement of scapula kinematics during dynamic movements in vivo. Journal of Shoulder and Elbow Surgery 2001;10:269-277 16. Ludwig PM, Cook TM. Alterations in shoulder kinematics and associated muscle activity in people with symptoms of shoulder impingement. Physical Therapy 2000;80(3):276-291 17. Norris C. Sports Injuries: diagnosis and management for physiotherapists. Butterworth Heinemann 1993. ISBN 0750601566 18. Otis JC et al. Changes in the moment arms of the rotator cuff and deltoid muscles with abduction and rotation. Journal of Bone and joint Surgery 1994;76A(5):667-676 19. Park HB et al. Diagnostic accuracy of clini- cal tests for the different degrees of subacromi-

al impingement syndrome. The Journal of Bone and Joint Surgery 2005;87A(7):1446-1455 20. Kennedy J, Hawkins R, Krissof W. Orthopaedic manifestations of swimming. American Journal of Sports Medicine 1978;6:309-322

INTERACTIVE FEATURES Printable flow chart/practi- tioner prompt outlining the

format and order of the assessment and examination process. Video clips of each of the tests outlined in table 2.

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