Empty Can Test: Difference between revisions

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== Purpose  ==
The '''Empty Can Test''', also known as the Jobe or Supraspinatus test, is used to assess for lesions of the rotator cuff, specifically the [https://physio-pedia.com/Supraspinatus#share supraspinatus muscle] and [https://physio-pedia.com/Supraspinatus_Tendinopathy#share supraspinatus tendon]. <ref name=":0">Magee D. J. Shoulder. Orthopedic Physical Assessment. 7th Edition. Philadelphia. Elsevier. 2022.</ref>


== Purpose<br>  ==
== Technique ==


The Empty Can Test is used to assess the [http://www.rad.washington.edu/academics/academic-sections/msk/muscle-atlas/upper-body/supraspinatus supraspinatus] muscle and tendon.<br>  
# The patients arm is actively abducted to 90<sup>o</sup>
# The examiner applies downward resistance to the abducted arm
# With the patient's hand in a fist, and the thumb sticking out, the shoulder is actively <u>internally rotated</u>, and angled forward to 30<sup>o</sup>, so that their thumb is in a downward facing direction (empty can position), in the scapular plane 


== Technique<ref>Jobe, F.W., Moynes D.R. (1982) Delineation of diagnostic criteria and a rehabilitation program for rotator cuff injuries. American Journal of Sports Medicine. 10, 336-339</ref><br>  ==
== Instructional Video ==
Here is a video demonstrating the Empty Can Test:{{#ev:youtube|mC_5Lmy7iAo}}<ref>Clinical Physio. Empty Can Test for Shoulder | Clinical Physio Premium. Available from: https://www.youtube.com/watch?v=mC_5Lmy7iAo&ab_channel=ClinicalPhysio (accessed 17/05/2024). </ref>


The patient can be seated or standing for this test. The patient's arm should be elevated to 90 degrees in the scapular plane, with the elbow extended, full internal rotation, and pronation of the forearm. This results in a thumbs-down position, as if the patient were pouring liquid out of a can. The therapist should stabilize the shoulder while applying a downwardly directed force to the arm, the patient tries to resist this motion. This test is considered positive if the patient experiences pain or weakness with resistance.  
== Interpretation ==
Testing the arm with the thumb in 'thumbs up' (full can position) is most suitable for maximal contraction of the supraspinatus muscle. <ref name=":0" />


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Resistance is provided by the examiner, as they are assessing for weakness or pain. Weakness or pain would represent a positive test, which would indicate a tear of the supraspinatus muscle or tendon, or a neuropathy of the suprascapular nerve. <ref name=":0" />
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| {{#ev:youtube|qjHOqydDhxo|300}}
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| <ref>Online video, http://www.youtube.com/watch?v=qjHOqydDhxo, last accessed 02/03/09</ref>
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== Evidence  ==
This can also indicate supraspinatus paratenonitis. <ref name=":0" />


Provide the evidence for this technique here
== Evidence ==
Boettcher CE, et al. demonstrated with normalized EMG that the Empty Can Test activates supraspinatus to levels approximately 90% MVC. Concurrent activation of other shoulder muscles tested including other rotator cuff muscles (infraspinatus and upper subscapularis), scapular positioning muscles (upper, middle and lower trapezius, and serratus anterior), and abduction torque producing muscles (anterior, middle &amp; posterior deltoid) were activated to similarly high levels. <ref>Boettcher CE, Ginn KA, Cathers I. The ‘empty can’ and ‘full can’ tests do not selectively activate supraspinatus. J Sci Med Sport (2008), doi:10.1016/j.jsams.2008.09.005</ref>


== Resources ==
Therefore, the Empty Can Test must be questioned as a valid diagnostic tool for isolated supraspinatus pathology, due to the high activation of many shoulder muscles simultaneously.


add relevant resources here
The Empty Can Test has a '''specificity''' of 55% for Pain, 68% for muscle weakness, as well as 50% for pain, muscle weakness, or both.  <ref name=":0" />       


== References<br>  ==
The Empty Can Test has a '''sensitivity''' of 63% for Pain, 77% for muscle weakness, as well as 89% for pain, muscle weakness, or both. <ref name=":0" />
 
There is a '''positive likelihood ratio''' of 1.40 for pain, 2.41 for muscle weakness, and 1.78 for pain, muscle weakness, or both. <ref name=":0" />
 
There is a '''negative likelihood ratio''' of 0.67 for pain, 0.34 for muscle weakness, and 0.22 for pain, muscle weakness, or both. <ref name=":0" />
 
== References ==


<references />  
<references />  


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Latest revision as of 20:51, 25 May 2024

Purpose[edit | edit source]

The Empty Can Test, also known as the Jobe or Supraspinatus test, is used to assess for lesions of the rotator cuff, specifically the supraspinatus muscle and supraspinatus tendon. [1]

Technique[edit | edit source]

  1. The patients arm is actively abducted to 90o
  2. The examiner applies downward resistance to the abducted arm
  3. With the patient's hand in a fist, and the thumb sticking out, the shoulder is actively internally rotated, and angled forward to 30o, so that their thumb is in a downward facing direction (empty can position), in the scapular plane

Instructional Video[edit | edit source]

Here is a video demonstrating the Empty Can Test:

[2]

Interpretation[edit | edit source]

Testing the arm with the thumb in 'thumbs up' (full can position) is most suitable for maximal contraction of the supraspinatus muscle. [1]

Resistance is provided by the examiner, as they are assessing for weakness or pain. Weakness or pain would represent a positive test, which would indicate a tear of the supraspinatus muscle or tendon, or a neuropathy of the suprascapular nerve. [1]

This can also indicate supraspinatus paratenonitis. [1]

Evidence[edit | edit source]

Boettcher CE, et al. demonstrated with normalized EMG that the Empty Can Test activates supraspinatus to levels approximately 90% MVC. Concurrent activation of other shoulder muscles tested including other rotator cuff muscles (infraspinatus and upper subscapularis), scapular positioning muscles (upper, middle and lower trapezius, and serratus anterior), and abduction torque producing muscles (anterior, middle & posterior deltoid) were activated to similarly high levels. [3]

Therefore, the Empty Can Test must be questioned as a valid diagnostic tool for isolated supraspinatus pathology, due to the high activation of many shoulder muscles simultaneously.

The Empty Can Test has a specificity of 55% for Pain, 68% for muscle weakness, as well as 50% for pain, muscle weakness, or both. [1]

The Empty Can Test has a sensitivity of 63% for Pain, 77% for muscle weakness, as well as 89% for pain, muscle weakness, or both. [1]

There is a positive likelihood ratio of 1.40 for pain, 2.41 for muscle weakness, and 1.78 for pain, muscle weakness, or both. [1]

There is a negative likelihood ratio of 0.67 for pain, 0.34 for muscle weakness, and 0.22 for pain, muscle weakness, or both. [1]

References[edit | edit source]

  1. 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 Magee D. J. Shoulder. Orthopedic Physical Assessment. 7th Edition. Philadelphia. Elsevier. 2022.
  2. Clinical Physio. Empty Can Test for Shoulder | Clinical Physio Premium. Available from: https://www.youtube.com/watch?v=mC_5Lmy7iAo&ab_channel=ClinicalPhysio (accessed 17/05/2024).
  3. Boettcher CE, Ginn KA, Cathers I. The ‘empty can’ and ‘full can’ tests do not selectively activate supraspinatus. J Sci Med Sport (2008), doi:10.1016/j.jsams.2008.09.005