Rotator Cuff Pathology/Impingement
Drop arm test
The patient is positioned in sitting or standing with the arm in 90 degrees of abduction. The patient is asked to slowly lower the arm to their side. A positive test is indicated by the patient failing to slowly lower the arm to their side or by the presence of severe pain and may be indicative of a tear in the rotator cuff
Hawkins-Kennedy impingement test
The patient is positioned in sitting or standing. The therapist flexes the patient’s shoulder to 90 degrees and then medially rotates the arm. A positive test is indicated by pain and may be indicative of shoulder impingement involving the supraspinatus tendon
Infraspinatus test
The patient stands with their elbow flexed to 90 degrees and the shoulder in 45 degrees of medial rotation. The patient then resists as the therapist applies a medially directed force to the forearm. Pain or weakness indicates the presence of an Infraspinatus strain/tear
Lateral rotation lag sing
With the patient’s elbow bent, the therapist passively moves their shoulder into 20 degrees of scaption and near end-range lateral rotation and asks the patient to hold that position. The test is positive for infraspinatus and/or supraspinatus pathology if the patient cannot hold the position (i.e. shoulder moves into more medial rotation). This test can also be performed with the patient’s shoulder in varying levels of elevation
Lift off sign (medial rotation lag sign)
The patient stands and places the dorsum of their hand on their low back. The patient is asked to move their hand away from their back. If they are unable to do this, the therapist should passively move the patient’s hand away from their back and see if they can hold the position. An inability to hold the position indicates that a subscapularis lesion is present
Neer impingement test
The patient is positioned in sitting or standing. The therapist positions one hand on the posterior aspect of the patient’s scapula and the other hand stabilizing the elbow. The therapist elevates the patient’s arm through flexion. A positive test is indicated by a facial grimace or pain and may be indicative of shoulder impingement involving the supraspinatus tendon
Supine impingement test
The patient lies supine while the therapist Passively moves the shoulder into full flexion. The therapist then laterally rotates and adducts the shoulder so that the arm is near the patient’s head. From this position, the therapist medially rotates the Shoulder the test is positive if the patient experiences a significant increase in pain with medial rotation
Supraspinatus test
The patient is positioned with the arm in 90 degrees of abduction followed by 30 degrees of horizontal adduction with the thumb pointing downward. The therapist resists the patient’s attempt to abduct the arm. A positive test is indicated by weakness or pain and may be indicative of tear of the supraspinatus tendon, impingement or suprascapular nerve involvement