Adhesive capsulitis abduction test This tests for frozen shoulder at the glenohumeral joint. The client can be seated or standing. The therapist stands behind the client and holds the client’s affected arm above the elbow and at the wrist and attempts to slowly abduct the client’s arm out to 90 degrees. Frozen shoulder is indicated by pain accompanied by a limited ROM (under 90 degrees). The therapist can apply most manual therapy technique for the hypertonic muscles around the affected joint but should let the client know that such techniques are not a long-term solution for this condition since its cause is, in most cases, idiopathic (unknown) and affect the joint capsule itself rather than the musculature (Cleland et al., 2020). Drop arm test This tests for weakness or dysfunction of either the deltoid or supraspinatus muscle. The client can be seated or standing. The client will abduct their arm to 90 degrees, hold the position for a moment, if possible, then slowly adduct their arm to their body. Weakness or a dysfunction of the deltoid is indicated by pain at the muscle’s attachments or in its belly. Weakness or dysfunction of the supraspinatus is indicated by pain above the spine of the scapula or near the greater tubercle of the humerus and may indicate a rotator cuff tear. (See next test.) Weakness, as a symptom of its own, of either muscle is indicated by the client being unable to slowly or smoothly abduct or adduct their arm. Cross-fiber friction at the attachments is effective for these muscles (Cleland et al., 2020). Hawkins-Kennedy impingement test Tests for impingement or injury to the supraspinatus tendon. With the client seated or standing, they are asked to abduct their arm to 90 degrees and, keeping their elbow in full extension, medially or downwardly rotate their humerus at the elbow. A supraspinatus muscle tear or impingement is indicated by pain at, near, or underneath the acromion of the scapula. The client should consult a physician for a diagnosis (Cleland et al., 2020). Painful arc test This tests for a supraspinatus tendon and subacromial bursa impingement. With the client seated or standing with their arms by their side, the client abducts the affected shoulder through its full ROM, to 180 degrees if possible. A positive result is indicated by pain at, near, or underneath the acromion starting at 70 degrees of abduction and easing after 130 degrees of abduction. Positive results should be referred to a physician or doctor of physical therapy for diagnosis (Cleland et al., 2020). Healthcare Consideration: Of the four rotator cuff muscles—supraspinatus, infraspinatus, teres minor, and subscapularis—supraspinatus, specifically its distal tendon at the greater tubercle of head of the humerus, is the most common rotator cuff injury. All positive results of orthopedic tests should be diagnosed by a physician or doctor of physical therapy (Cleland et al., 2020). Lateral/external rotators strength test This procedure tests for weakness or dysfunction of the infraspinatus and/or teres minor muscles. With the client seated or standing, they keep their arm by their side while flexing the elbow to 90 degrees. They are then asked to laterally/externally rotate their arm while the therapist resists their motion with internal rotation. A dysfunction of the infraspinatus is indicated by pain in the muscle belly on the posterior scapula. A weakness of infraspinatus is indicated by an inability of the client to maintain strength against the therapist’s resistance. A dysfunction of teres minor is
Posterior deltoid strength test This tests for weakness of the posterior deltoid. The client should be in the prone position, their arm on the side being tested abducted to 90 degrees and elbow flexed to 90 degrees so that it is draped off the table. The client will hold their arm in this position while resisting the therapist’s push at the elbow toward the floor. A weakness of the posterior portion of the deltoid muscle is indicated by the client’s inability to resist the therapist’s directed pressure. If a client has pain occur near the spine of the scapula, it is the muscle tendon at the attachment that may be injured. The massage therapist should check for signs of inflammation, and if none is present, can proceed with cross-fiber friction along the distal aspect of the spine of the scapula to initiate healing (Cleland et al., 2020). Shoulder extensors test This tests for hypomobility of the muscles that extend the shoulder, particularly the latissimus dorsi. The client will be laying supine with their knees bent to 45 degrees so that the latissimus dorsi is not stretched due to spinal lordosis. The client then fully flexes their arms over their head until their arms are resting on the therapy table or otherwise aligned with the client’s body. Hypomobility, normally due to the hypertonicity of the latissimus dorsi and possibly teres major and posterior deltoid muscles, is indicated if the client cannot rest their arms on the table. Myofascial release, PNF stretches, and trigger point therapy (for the bellies of latissimus dorsi and teres major) are all indicated. Pectoralis major length test This tests for hypertonicity of the pectoralis major. The client should be in the supine position on the therapy table with the edge of their torso parallel to the edge of the table. The client’s arm is then abducted to 90 degrees and released. Hypertonicity of the muscle’s sternal and costal fibers is indicated by the arm not dropping below table-top level. To test the clavicular fibers of the pectoralis major, the client’s arm should be abducted to 135 degrees. Hypertonicity of the clavicular fibers is indicated by the arm not dropping below table level. Cross-fiber friction along the medial clavicle, lateral sternum, and inferior ribs may help relieve the hypertonicity (Cleland et al., 2020). Pectoralis minor length test This tests for hypertonicity of the pectoralis minor. The client will be supine on the table. The therapist sits at the head of the table and observes the position of the shoulders. Hypertonicity of the pectoralis minor is indicated by an abduction of the shoulder over 20 degrees. The therapist should then press down on the affected side (bilaterally if both sides appear affected) and ask if the client feels a stretch in the pectoralis minor area to confirm their observations. Cross-fiber friction at the coracoid process, as well as PNF stretches, directional massage, and myofascial release may be of use in relieving the hypertonicity (Cleland et al., 2020). Acromioclavicular (AC) joint shear test This tests for the integrity of the AC joint ligaments. The client should be in a seated position with the therapist standing behind the client. The therapist will interlace their fingers with the palm of one hand on the lateral aspect of the clavicle and the other palm on the client’s lateral spine of the scapula. The therapist then squeezes their hands together. Dysfunctional AC joint ligaments are indicated by pain or excessive movement of the joint. The therapist should use cold therapy to reduce pain before attempting cross-fiber friction on the AC joint to initiate tissue repair. Avoid moving the shoulder joint and perhaps stabilize it with a sports wrap or tape (Cleland et al., 2020).
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Book Code: MTX1326
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