Subacromial Impingement Cluster: Difference between revisions

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== Purpose ==
== Purpose ==


To test for the presence of subacromial impingement  
To test for the presence of subacromial impingement  


==Tests for Subacromial Impingement<sup>1,2</sup>==
== Tests for Subacromial Impingement<sup>1,2</sup> ==


'''Hawkins-Kennedy''': SN:&nbsp; .63 (.39–.86) SP:&nbsp; .62 (.46–.77) +LR:&nbsp; 1.63 (.94–2.81)
'''Hawkins-Kennedy''': SN:&nbsp; .63 (.39–.86) SP:&nbsp; .62 (.46–.77) +LR:&nbsp; 1.63 (.94–2.81)  


*Testing:&nbsp; Shoulder is flexed to 90 degrees and then internally rotated with elbow flexed to 90 degrees.
*Testing:&nbsp; Shoulder is flexed to 90 degrees and then internally rotated with elbow flexed to 90 degrees.
*Positive Test:&nbsp; Pain with IR.


Positive Test:&nbsp; Pain with IR.<br>'''Neer''': SN:&nbsp; .81 (.62–1.0) SP:&nbsp; .54 (.38–.69) +LR:&nbsp; 1.76 (1.17–2.66)  
'''Neer''': SN:&nbsp; .81 (.62–1.0) SP:&nbsp; .54 (.38–.69) +LR:&nbsp; 1.76 (1.17–2.66)  


*Testing:&nbsp; Examiner stablizers scapula and flexes shoulder until pain is felt or end of ROM.
*Testing:&nbsp; Examiner stablizers scapula and flexes shoulder until pain is felt or end of ROM.  
*Positive Test:&nbsp; Pain with flexion


Positive Test:&nbsp; Pain with flexion<br>'''Painful arc''':&nbsp; SN:&nbsp; &nbsp;.75 (.54–.96) SP:&nbsp; .67 (.52–.81) +LR:&nbsp; 2.25 (1.33–3.81)
'''Painful arc''':&nbsp; SN:&nbsp; &nbsp;.75 (.54–.96) SP:&nbsp; .67 (.52–.81) +LR:&nbsp; 2.25 (1.33–3.81)  


*Testing:&nbsp; Shoulder is elevated in scaption and then slowly lowered.
*Testing:&nbsp; Shoulder is elevated in scaption to full elevation and then lowered in same motion.  
*Positive Test:&nbsp; Pain or pain from 60 to 120 degrees scaption&nbsp;


Positive Test:&nbsp; Pain or pain from 60 to 120 degrees scaption&nbsp;<br>'''Empty can (Jobe):&nbsp; '''SN:&nbsp; .50 (.26–.75) SP:&nbsp; .87 (.77–.98) +LR:&nbsp; 3.90 (1.50–10.12)  
'''Empty can (Jobe):&nbsp; '''SN:&nbsp; .50 (.26–.75) SP:&nbsp; .87 (.77–.98) +LR:&nbsp; 3.90 (1.50–10.12)  


*Testing:&nbsp; Shoulder abducted to 90 degrees and slightly adducted.&nbsp; Shoulder internally rotated and downward force applied.
*Testing:&nbsp; Shoulder abducted to 90 degrees and slightly adducted.&nbsp; Shoulder internally rotated and downward force applied.
*Positive Test:&nbsp; Pain or inability to maintain abduction.


Positive Test:&nbsp; Pain or inability to maintain abduction.<br>'''External rotation resistance: '''SN:&nbsp; .56 (.32–.81) SP:&nbsp; .87 (.77–.98) +LR:&nbsp; 4.39 (1.74–11.07) .50  
'''External rotation resistance: '''SN:&nbsp; .56 (.32–.81) SP:&nbsp; .87 (.77–.98) +LR:&nbsp; 4.39 (1.74–11.07) .50  


Testing:&nbsp; Elbow flexed to 90 degrees and adducted to trunk with neutral rotation.&nbsp; Medially directed force applied.
*Testing:&nbsp; Elbow flexed to 90 degrees and adducted to trunk with neutral rotation.&nbsp; Medially directed force applied.  
*Positive Test:&nbsp; Pain or weakness


Positive Test:&nbsp; Pain or weakness
'''Cross-body adduction test''':&nbsp; SN:&nbsp; .23&nbsp; SP:&nbsp; .82&nbsp;
 
*Testing:&nbsp; Shoulder is elevated to 90 degrees and adducted across body.
*Positive Test:&nbsp; Pain with adduction
 
'''Drop arm sign''':&nbsp; SN:&nbsp; .27&nbsp; SP:&nbsp; .88
 
*Testing:&nbsp; Shoulder is elevated to full flexion and asked to slowly lower.
*Positive Test:&nbsp; Severe pain or inability to slowly lower.
 
==Clusters==
 
If three of the following test are positive:&nbsp; Hawkins-Kennedy, neer, painful arc, empty can, and external rotation resistance then SN:&nbsp;&nbsp;.75 (.54–.96) SP:&nbsp; .74 (.61–.88) +LR:&nbsp; 2.93 (1.60–5.36) -LR:&nbsp; .34 (.14–.80).<sup>1</sup>
 
If&nbsp;Painfui arc sign, Drop-arm sign, Infraspinatus muscle test positive the +LR:&nbsp; 15.57 of full thickness rotator cuff tear.<sup>2</sup>&nbsp;
 
If Hawkins-Kennedy impingement sign, Painfui arc sign, Infraspinatus muscle test positive then +LR:&nbsp; 10.56 of some type of impingement present.<sup>2</sup>
 
 
 
==References==
 
(1)&nbsp; Michener LA, Walsworth MK, Doukas WC, Murphy KP.&nbsp; Reliability and diagnostic accuracy of 5 physical examination tests and combination of tests for subacromial impingement.&nbsp;&nbsp;Arch Phys Med Rehabil. 2009 Nov;90(11):1898-903.<br>
 
(2)&nbsp; Park HB, Yokota A, Gill HS, El Rassi G, McFarland EG.&nbsp; Diagnostic accuracy of clinical tests for the different degrees of subacromial impingement syndrome.&nbsp; J Bone Joint Surg Am. 2005 Jul;87(7):1446-55.

Revision as of 06:04, 12 December 2009

Purpose[edit | edit source]

To test for the presence of subacromial impingement

Tests for Subacromial Impingement1,2[edit | edit source]

Hawkins-Kennedy: SN:  .63 (.39–.86) SP:  .62 (.46–.77) +LR:  1.63 (.94–2.81)

  • Testing:  Shoulder is flexed to 90 degrees and then internally rotated with elbow flexed to 90 degrees.
  • Positive Test:  Pain with IR.

Neer: SN:  .81 (.62–1.0) SP:  .54 (.38–.69) +LR:  1.76 (1.17–2.66)

  • Testing:  Examiner stablizers scapula and flexes shoulder until pain is felt or end of ROM.
  • Positive Test:  Pain with flexion

Painful arc:  SN:   .75 (.54–.96) SP:  .67 (.52–.81) +LR:  2.25 (1.33–3.81)

  • Testing:  Shoulder is elevated in scaption to full elevation and then lowered in same motion.
  • Positive Test:  Pain or pain from 60 to 120 degrees scaption 

Empty can (Jobe):  SN:  .50 (.26–.75) SP:  .87 (.77–.98) +LR:  3.90 (1.50–10.12)

  • Testing:  Shoulder abducted to 90 degrees and slightly adducted.  Shoulder internally rotated and downward force applied.
  • Positive Test:  Pain or inability to maintain abduction.

External rotation resistance: SN:  .56 (.32–.81) SP:  .87 (.77–.98) +LR:  4.39 (1.74–11.07) .50

  • Testing:  Elbow flexed to 90 degrees and adducted to trunk with neutral rotation.  Medially directed force applied.
  • Positive Test:  Pain or weakness

Cross-body adduction test:  SN:  .23  SP:  .82 

  • Testing:  Shoulder is elevated to 90 degrees and adducted across body.
  • Positive Test:  Pain with adduction

Drop arm sign:  SN:  .27  SP:  .88

  • Testing:  Shoulder is elevated to full flexion and asked to slowly lower.
  • Positive Test:  Severe pain or inability to slowly lower.

Clusters[edit | edit source]

If three of the following test are positive:  Hawkins-Kennedy, neer, painful arc, empty can, and external rotation resistance then SN:  .75 (.54–.96) SP:  .74 (.61–.88) +LR:  2.93 (1.60–5.36) -LR:  .34 (.14–.80).1

If Painfui arc sign, Drop-arm sign, Infraspinatus muscle test positive the +LR:  15.57 of full thickness rotator cuff tear.2 

If Hawkins-Kennedy impingement sign, Painfui arc sign, Infraspinatus muscle test positive then +LR:  10.56 of some type of impingement present.2


References[edit | edit source]

(1)  Michener LA, Walsworth MK, Doukas WC, Murphy KP.  Reliability and diagnostic accuracy of 5 physical examination tests and combination of tests for subacromial impingement.  Arch Phys Med Rehabil. 2009 Nov;90(11):1898-903.

(2)  Park HB, Yokota A, Gill HS, El Rassi G, McFarland EG.  Diagnostic accuracy of clinical tests for the different degrees of subacromial impingement syndrome.  J Bone Joint Surg Am. 2005 Jul;87(7):1446-55.

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