In order to find out the causes of shoulder and arm pain, you need an experienced expert who knows where the symptoms come from and which specific functional tests need to be carried out for the various diseases.
As part of a thorough examination, the following factors are assessed:
- Brawn
- Possibility of movement
- Functionality of the shoulder joint
Clinical evaluation tests give the doctor the opportunity to make a diagnosis; Imaging tests, such as an MRI, may also be prescribed to confirm this.
Contents
Functional tests for impingement or subacromial syndrome
Neer test
The Neer sign occurs when the supraspinatus tendon is pinched under the coracoacromial arch of the raven’s beak process and acromion.
In the test, the arm is lifted sideways with the shoulder turned inwards. The shoulder blade must be fixed in order to avoid the shoulder blade-chest movement. Pain is considered a sign of the presence of subacromial impingement.
Hawkins test
The test according to Hawkins is often done to assess impingement syndrome.
The examiner captures:
- the patient’s arm near the elbow with one hand,
- the patient’s wrist with the other hand.
In the Hawkins test, the patient’s arm is raised forward (90°) while the shoulder is turned inward.
If pain occurs, subacromial impingement may be present.
A study has shown that the Hawkins functional test for detecting shoulder impingement syndrome shows more accurate results than the Neer test.
Yocum test
Patient and examiner stand upright.
Position of the patient: The hand of the arm to be evaluated rests on the opposite shoulder.
The yocum test consists of pushing the elbow upwards against the resistance of the examiner.
If pain occurs, the test is positive and can therefore indicate subacromial syndrome.
Functional tests for the rotator cuff
Orthopedic tests to assess the rotator cuff include:
Drop-arm characters
A rupture of the rotator cuff can be detected with this movement test.
In the drop-arm test, the patient’s arm is raised sideways; the elbow is stretched and the hand reaches the height of the shoulder.
When the arm falls down, there is a lesion of the rotator cuff, especially the supraspinatus.
The patient may be able to slowly lower the arm to 90° (because this movement is mainly performed by the deltoid muscle), but not beyond.
Jobe test: This test
is most commonly performed to determine if there is a lesion or inflammation of the supraspinatus tendon.
- Position of the patient: standing upright, the arm is placed in a 90° abduction as well as a 30° flexion. The thumb is pointing down.
- Position of the examiner: stands next to the patient and grasps his wrist.
- Procedure: the doctor presses down while the patient tries to withstand the pressure.
The test is positive if the patient feels pain or is unable to withstand the pressure.
Functional test for the acromioclavicular joint
Cross-arm test
Patients with malfunctions of the acromioclavicular joint (AC joint) often have shoulder pain.
The cross-arm test can be used to isolate the AC joint.
The patient raises the arm in question (90°).
The examiner performs adduction of the arm, with the acromion pressing against the end of the clavicle far from the body.
Pain in the acromioclavicular joint means a positive test result.
This is to be expected in the case of:
- acromioclavicular arthritis,
- acromioclavicular diastasis,
- Lesion of a ligament located between the two bones.
Tests for shoulder instability
With the help of the tests described here, the stability of the shoulder joint (glenohumeral joint) can be evaluated.
The healthy arm is also examined so that it can be compared with the diseased side.
Anterior instability test
In the anterior instability test, the patient lies on his back or sits upright and holds the arm spread apart (90° abduction) in the neutral position.
- The examiner holds the patient’s arm with one hand.
- The other hand grasps the patient’s wrist.
The examiner fixes the upper arm and turns the shoulder outwards. The pain or fear of an imminent subluxation or dislocation indicates anterior instability of the shoulder joint.
Rear instability test
The posterior instability of the shoulder joint can be determined with a simple test: the patient lies on his back or sits upright, keeping his arm spread apart at 90° and his elbow bent at 90°.
The examiner presses on the head of the humerus from behind.
Pain or the sensation of a protruding arm indicates that there is posterior instability.
Furrow Formation
Test Patient and examiner stand. The patient’s arm is in a neutral position; the examiner grasps the wrist, pulls the arm downwards, and observes whether a furrow or depression forms on the side of the shoulder under the acromion.
A delivered furrow indicates an instability of the shoulder joint downwards. The examiner should keep in mind that, as a rule, many patients without symptoms, especially adolescents, have some degree of instability.
Relocation test
The relocation test is carried out following a positive instability test.
Position of the patient as in the instability test: The patient lies on his back with his arm spread apart and bent at 90°, the elbow has a right angle.
In this position, the patient feels pain.
The examiner presses on the head of the humerus from behind.
If pain or fear of dislocation subsides, there may be anterior instability of the shoulder joint.
Tests for the biceps muscle of the shoulder
Yergason test The Yergason test
is performed to assess the tendon of the upper arm biceps.
Position of the patient: Standing with relaxed arms and elbow against the chest.
The patient’s elbow is initially bent by 90°, the thumb points upwards.
The patient must bend the elbow and supinate the forearm (turn the thumb outwards), while the examiner holds the wrist and exerts an opposing force.
If there is pain in the anterior region of the shoulder,
- and if there is no snapping of the tendon, there is tendinitis of the biceps tendon or a lesion of the cartilaginous lip of the scapula;
- if the maneuver causes the tendon to jump out of the biceps groove, this is an indication of a tear or overstretching of the upper armband.
Palm-up test or Gilchrist sign
The palm-up test is used to assess the long biceps tendon.
The patient’s elbow is extended, the forearm is turned outwards, i.e. supinated (the palm points upwards) and the arm is stretched forward at about shoulder height.
The patient must now push the arm upwards and the examiner pushes the arm down at the level of the wrist.
Tests for the labrum glenoidale
Fulcrum Review
Injuries to the cartilaginous lip of the shoulder blade (labrum glenoidale) are checked while the patient is lying on his back.
The shoulder rests on the outer edge of the treatment table.
The examiner places one hand behind the shoulder and the other on the wrist.
Now he spreads the shoulder up to 90° and turns the arm outwards from this position, while pushing the head of the humerus forward.
If a crack is heard or pain occurs during the maneuver, the test can be evaluated positively.
O’Brien test
Position of the patient: relaxed sitting or standing.
The arm is in 90° flexion, 10° adduction and full internal rotation (thumb pointing down).
The examiner pushes the arm down, while the patient holds against it and pushes upwards.
The test must be repeated, this time the arm is in a neutral position (thumb pointing up).
Evaluation of the result:
The test is considered positive if pain or snapping occurs while the arm is turned inward, but not while the arm is in a neutral position.
Pain at the level of the acromioclavicular joint indicates problems in this area.
If the patient has deep pain in the shoulder, the test is positive due to a lesion of the cartilaginous lip of the scapula.
If there are problems with the acromioclavicular joint, the patient has pain in both test positions.
Read more:
