● Acromioclavicular active compression test (O’Brien test) : To perform this test, the examiner passively places the shoulder in 90 degrees of shoulder flexion and 10 to 15 degrees of horizontal adduction. In this position, the patient then fully internally rotates the shoulder and pronates the forearm. The patient is instructed to apply an upward force while the examiner provides a distal stabilizing force. Next, the shoulder is placed in an externally rotated position with the forearm in supination, and the examiner again provides a distal stabilizing force while the patient provides an upward force. The test is positive if the first position reproduces pain or clicking while the second position eliminates or reduces it (O’Brien et al., 1998). ● Cross-body adduction stress test : For this test (also called the scarf test ), the examiner passively brings the patient’s arm into 90 degrees of forward flexion and 90
degrees of elbow flexion. The examiner then passively horizontally adducts the arm across the patient’s body, bringing the flexed elbow toward the contralateral shoulder. This movement compresses the medial acromial facet against the distal clavicle to provoke acromioclavicular joint symptoms (Park et al., 2005). ● Paxino test : For this test, the examiner stands behind the seated client, who has their affect affected arm at their side. The examiner’s thumb is placed under the posterolateral aspect of the acromion while the index and middle fingers are placed on the superior surface of the mid-clavicle. The examiner applies anterosuperior directed pressure through the acromion with the thumb while simultaneously applying pressure in an inferior direction on the clavicle with the index and middle fingers. The test is positive if it causes or increases pain in the acromioclavicular joint (Walton et al., 2004).
ROTATOR CUFF TEARS
patient cannot maintain the position against gravity. This test has been reported to have a sensitiCo2020). ● Jobe test : The Jobe test is used to assess supraspinatus function. When patients have a full-thickness rotator cuff tear, this test has a sensitive of 52.6% and a specificity of 82.4%. For partial-thickness tears, the sensitivity for this test is 32.1% and the specificity is 67.8% (Cotter et al., 2018). ● External rotation lag sign : The external rotation lag sign can be used to identify infraspinatus weakness. For this test, the patient’s elbow is flexed to 90 degrees and the shoulder is passively externally rotated 20 to 30 degrees. The patient is asked to maintain this externally rotated position. An inability to maintain the externally rotated position is considered a positive sign (Cotter et al., 2018). According to Cotter et al. (2018), this test is considered both highly sensitive (97%) and highly specific (93%) for combined full-thickness tears of the supraspinatus and infraspinatus. ● Hornblower sign : The Hornblower sign can help identify teres minor tears. The teres minor is a shoulder external rotator when the shoulder is abducted to 90 degrees in the scapular plane. Isolated tears to this muscle are uncommon (Cotter et al., 2018). For this test, the patient’s shoulder is abducted to 90 degrees in the scapular plane and the elbow is flexed to 90 degrees. The patient holds this position while they externally rotate against resistance. The test is positive if the arm falls into internal rotation. This test has been found to be 100% sensitive and 94% specific for rotator cuff pathology involving the teres minor (Cotter et al., 2018). The subscapularis may be torn in isolation or with anterosuperior rotator cuff tears (Cotter et al., 2018). When weakness is present with resistance to internal rotation, subscapularis may be involved. Three specific tests can be used to assess subscapularis function: the belly press test, the lift off test, and bear hug test. Special tests for subscapularis muscle involvement include: ● Belly press test : For the belly press test, the patient places their hand on their abdomen and presses on their belly while holding the elbow in the coronal plane. A positive test occurs when the elbow is not able to remain in the coronal plane but moves posteriorly. This occurs because of the need to recruit other muscles to complete the test due to subscapularis weakness. This test has been shown to have a sensitivity of 80% and a specificity of 88% for subscapularis tears (Cotter et al., 2018).
Rotator cuff tears are a common shoulder injury (Cotter et al., 2018), and their frequency increases with age. People in their 60s have about a 25% incidence of full-thickness tears. The frequency increases to more than 50% for those in their 80s (Edwards et al., 2016). According to Katsuura et al. (2020), there is evidence that neurologic dysfunction contributes to the etiology of rotator cuff tears. The rotator cuff plays a role in movement of the shoulder and in stabilizing the glenohumeral joint articulation. Four muscles form the myotendinous complex of the rotator cuff. These include the supraspinatus superiorly, the subscapularis anteriorly, and the teres minor and infraspinatus posteriorly (Edwards et al., 2016). The classification of rotator cuff tears depends on size of the tear, number of tendons involved, and reparability of the tear. A tear is considered massive when it is at least 5 cm or there is complete tearing of at least two tendons (Edwards et al., 2016). Tears can also be classified by location. Superior tears affect only the supraspinatus; superoposterior tears involve the supraspinatus and infraspinatus tendons; and superoanterior tears affect the supraspinatus, the subscapularis, and sometimes the long head of the biceps Clinical presentation varies by rotator cuff tear size and location. Some tears are asymptomatic, while others result in significant pain and loss of function (Edwards et al., 2016). Supraspinatus tears are characterized by constant pain, a painful arc (active abduction between 70 and 120 degrees), loss of shoulder abduction and elevation, weakness and pain with resistance to shoulder abduction or external rotation, and positive impingement signs (Edwards et al., 2016). Superoposterior tears involve a loss of active range of motion and weakness in external rotation with a positive lag sign (Edwards et al., 2016). Subscapularis tears include internal rotation weakness and an abnormal “lift-off” sign. Massive rotator cuff tears are often accompanied by scapulohumeral rhythm dysfunction and a compensatory shoulder shrug (Edwards et al., 2016). Muscle atrophy may develop over time (Edwards et al., 2016). Special tests for rotator cuff tears include: ● Drop arm test : The drop arm test may help identify supraspinatus pathology as well as large tears in the rotator cuff. For this test, the examiner passively abducts the patient’s arm to 90 degrees and asks them to hold that position. This test is considered positive if the (Edwards et al., 2016). Clinical Presentation
EliteLearning.com/Physical-Therapy
Page 23
Powered by FlippingBook