Painful Arc: Difference between revisions

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== Expert Opinion  ==
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'''Original Editor '''- [[User:Tyler Shultz|Tyler Shultz]]


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== Purpose  ==
Link to Expert<br>
[[File:Shoulder_joint_anatomy.png|right|frameless|200x200px]]This test is commonly used to identify possible [[Subacromial Impingement|subacromial impingement syndrome]]. As with most special tests, a positive result on performance of the painful arc is not a definitive indicator of a subacromial impingement.<ref>Cyriax J. Textbook of orthopaedic medicine: Volume one diagnosis of soft tissue lesions 8 th ed. London: Bailliere Tindall. 1984:59-60.</ref>
 
== '''Technique''' ==
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With the patient in either sitting or standing the patient should be instructed to abduct the arm in the scapular plane. While abducting the arm, if the patient experiences any pain in and around the glenohumeral joint the patient must tell the physiotherapist what they are experiencing. Once there is an onset of pain the physiotherapist will instruct the patient to continue abducting the arm as high as they can. One the patient gets to approximately 120 degrees of abduction there should be a reduction in the amount of pain being experienced. Following completion of the abduction movement the patient should then slowly reverse the motion, bring the arm back to neutral position via the movement of adduction. This test is considered to be positive if the patient experiences pain between 60 and 120 degrees of abduction which reduces once past 120 degrees of abduction.&nbsp;<ref>Flynn, T.W., Cleland, J.A., &amp; Whitman, J.M. (2008). User's guide to the musculoskeletal examination: Fundamentals for the evidence-based clinician. Buckner, Kentucky: Evidence in Motion</ref>
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== Purpose<br>  ==
{{#ev:youtube|wU-ppPL0JpQ}}  
 
This test is commonly used to identify possible [[Subacromial Impingement|subacromial impingement syndrome]].<br>
 
== Technique<br> ==
 
The patient should be instructed to abduct the arm in the scapular plane and then slowly reverse the motion, bring the arm back to neutral position.&nbsp; This test is considered to be positive if the patient experiences pain between 60 and 120 degrees of elevation. <ref>Flynn, T.W., Cleland, J.A., &amp;amp; Whitman, J.M. (2008). User's guide to the musculoskeletal examination: Fundamentals for the evidence-based clinician. Buckner, Kentucky: Evidence in Motion</ref><br>


== Evidence  ==
== Evidence  ==
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|+ Diagnostic Test Properties for Painful Arc Sign <ref>Calis, M., Akgun, K., Birtane, M., et al. (2000). Diagnostic values of clinical diagnostic tests in subacromial impingement syndrome. Ann Rheum Dis, 59, 44-47.</ref>  
|+ Diagnostic Test Properties for Painful Arc Sign <ref>Calis, M., Akgun, K., Birtane, M., et al. (2000). Diagnostic values of clinical diagnostic tests in subacromial impingement syndrome. Ann Rheum Dis, 59, 44-47.</ref><ref>Çalış M, Akgün K, Birtane M, Karacan I, Çalış H, Tüzün F. Diagnostic values of clinical diagnostic tests in subacromial impingement syndrome. Annals of the rheumatic diseases. 2000 Jan 1;59(1):44-7.</ref>  
|-
|-
| Sensitivity  
| Sensitivity  
| 0.33
| &nbsp; 0.33
|-
|-
| Specificity  
| Specificity  
| 0.81
| &nbsp; 0.81
|-
|-
| Positive Likelihood Ratio  
| Positive Likelihood Ratio  
| 1.70
| &nbsp; 1.70
|-
|-
| Negative Likelihood Ratio  
| Negative Likelihood Ratio  
| 0.84
| &nbsp;0.84
|}
|}


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== '''Test Item Cluster''' ==
When this test is combined as a cluster with the [[Hawkins / Kennedy Test|Hawkins-Kennedy Impingement Sign]] and the [[Infraspinatus Test|Infraspinatus test]], and all three tests report a positive, then the positive likelihood ratio is 10.56 and if all three tests are negative, the negative likelihood ratio is 0.17. If two of the three tests are positive, then the positive likelihood ratio is 5.03.<ref>Park, H.B., Yokota, A., Gill, H.S., EI RG, McFarland, E.G. (2005). Diagnostic accuracy of clinical tests for the different degrees of subacromial impingement syndrome. J Bone Joint Surg Am, 87(7), 1446-1455.</ref>
 
'''Painful arc, empty can and external rotation resistance''' are the (2 or more tests are positive) best combination for the diagnosis of [https://physio-pedia.com/Subacromial_Pain_Syndrome#share Subacromial Impingement Syndrome.]<ref name=":0">Chen CW, Pan ZE, Zhang C, Liu CL, Chen L. ''Zhongguo Gu Shang''. 2016;29(5):434-438.</ref>
 
'''Painful arc and external rotation resistance''' are the (both tests are negative) best combination for ruling out [https://physio-pedia.com/Subacromial_Pain_Syndrome#share Subacromial Impingement Syndrome.]<ref name=":0" />


'''Test Item Cluster:'''<br> When this test is combined as a cluster with the [[Hawkins / Kennedy Test|Hawkins-Kennedy Impingement Sign]] and the [[Infraspinatus Muscle Test|Infraspinatus test]], and all three tests report a positive, then the positive likelihood ratio is 10.56 and if all three tests are negative, the negative likelihood ratio is 0.17. If two of the three tests are positive, then the positive likelihood ratio is 5.03.<ref>Park, H.B., Yokota, A., Gill, H.S., EI RG, McFarland, E.G. (2005). Diagnostic accuracy of clinical tests for the different degrees of subacromial impingement syndrome. J Bone Joint Surg Am, 87(7), 1446-1455.</ref>
See [[Test Diagnostics|test diagnostics]] page for explanation of statistics.<br>


== References<br> ==
== References: ==


<references />  
<references />  


<br> <br>
[[Category:Special_Tests]]
[[Category:Shoulder - Special Tests]]
[[Category:Shoulder]]
[[Category:Shoulder - Assessment and Examination]]
[[Category:Musculoskeletal/Orthopaedics]]
[[Category:Primary Contact]]
[[Category:Sports Medicine]]
[[Category:Athlete Assessment]]
[[Category:Assessment]]

Latest revision as of 20:41, 20 August 2020

Original Editor - Tyler Shultz

Top Contributors - Tyler Shultz, Shaimaa Eldib, Admin, Rachael Lowe, Kim Jackson, Kai A. Sigel, Eric Robertson, 127.0.0.1, Evan Thomas, Oyemi Sillo, Naomi O'Reilly, Alex Curran, WikiSysop, Claire Knott, Wanda van Niekerk and Anas Mohamed

Purpose[edit | edit source]

Shoulder joint anatomy.png

This test is commonly used to identify possible subacromial impingement syndrome. As with most special tests, a positive result on performance of the painful arc is not a definitive indicator of a subacromial impingement.[1]

Technique[edit | edit source]

With the patient in either sitting or standing the patient should be instructed to abduct the arm in the scapular plane. While abducting the arm, if the patient experiences any pain in and around the glenohumeral joint the patient must tell the physiotherapist what they are experiencing. Once there is an onset of pain the physiotherapist will instruct the patient to continue abducting the arm as high as they can. One the patient gets to approximately 120 degrees of abduction there should be a reduction in the amount of pain being experienced. Following completion of the abduction movement the patient should then slowly reverse the motion, bring the arm back to neutral position via the movement of adduction. This test is considered to be positive if the patient experiences pain between 60 and 120 degrees of abduction which reduces once past 120 degrees of abduction. [2]

Evidence[edit | edit source]

Diagnostic Test Properties for Painful Arc Sign [3][4]
Sensitivity   0.33
Specificity   0.81
Positive Likelihood Ratio   1.70
Negative Likelihood Ratio  0.84


Test Item Cluster[edit | edit source]

When this test is combined as a cluster with the Hawkins-Kennedy Impingement Sign and the Infraspinatus test, and all three tests report a positive, then the positive likelihood ratio is 10.56 and if all three tests are negative, the negative likelihood ratio is 0.17. If two of the three tests are positive, then the positive likelihood ratio is 5.03.[5]

Painful arc, empty can and external rotation resistance are the (2 or more tests are positive) best combination for the diagnosis of Subacromial Impingement Syndrome.[6]

Painful arc and external rotation resistance are the (both tests are negative) best combination for ruling out Subacromial Impingement Syndrome.[6]

See test diagnostics page for explanation of statistics.

References:[edit | edit source]

  1. ↑ Cyriax J. Textbook of orthopaedic medicine: Volume one diagnosis of soft tissue lesions 8 th ed. London: Bailliere Tindall. 1984:59-60.
  2. ↑ Flynn, T.W., Cleland, J.A., & Whitman, J.M. (2008). User's guide to the musculoskeletal examination: Fundamentals for the evidence-based clinician. Buckner, Kentucky: Evidence in Motion
  3. ↑ Calis, M., Akgun, K., Birtane, M., et al. (2000). Diagnostic values of clinical diagnostic tests in subacromial impingement syndrome. Ann Rheum Dis, 59, 44-47.
  4. ↑ Çalış M, Akgün K, Birtane M, Karacan I, Çalış H, Tüzün F. Diagnostic values of clinical diagnostic tests in subacromial impingement syndrome. Annals of the rheumatic diseases. 2000 Jan 1;59(1):44-7.
  5. ↑ Park, H.B., Yokota, A., Gill, H.S., EI RG, McFarland, E.G. (2005). Diagnostic accuracy of clinical tests for the different degrees of subacromial impingement syndrome. J Bone Joint Surg Am, 87(7), 1446-1455.
  6. ↑ 6.0 6.1 Chen CW, Pan ZE, Zhang C, Liu CL, Chen L. Zhongguo Gu Shang. 2016;29(5):434-438.
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