Subacromial Impingement Cluster
Original Editor - Stacy Callow
Top Contributors - Admin, Stacy Callow, Tony Lowe, Anas Mohamed, Selena Horner, Kai A. Sigel, WikiSysop, Wanda van Niekerk and Manisha Shrestha
Purpose
To test for the presence of subacromial impingement
Tests for Subacromial Impingement[1][2]
Hawkins-Kennedy: Sensitivity (SN): .63 (.39–.86) Specificity(SP): .62 (.46–.77), Likelihood ratio(+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 scapular plane abduction to full elevation and then lowered in same motion.
- Positive Test: Pain or pain from 60 to 120 degrees scapular plane abduction
Empty can: 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
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 Painful 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, Painful arc sign, Infraspinatus muscle test positive then +LR: 10.56 of some type of impingement present[2]
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.[3]
Painful arc and external rotation resistance are the (both tests are negative) best combination for ruling out Subacromial Impingement Syndrome.[3]
References
- ↑ 1.0 1.1 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.
- ↑ 2.0 2.1 2.2 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.
- ↑ 3.0 3.1 Chen CW, Pan ZE, Zhang C, Liu CL, Chen L. Zhongguo Gu Shang. 2016;29(5):434-438.