Learning outcome
- Shoulder instability
- Tendinopathy and rupture of M. supraspinatus
- Subacromial impingement
- Labral injury
- Glenohumeral hypermobility
Special tests
- Apprehension test and Relocation test
- Empty can test
- Neer’s sign and test
- Hawkins test
- O’Brien’s test
- Glenohumeral translation (Sulcus sign)
Case 2
You are working as a 5th-year student in the surgical department at a local hospital. In the orthopedic outpatient clinic, you meet a 46-year-old man. Previously healthy. Works as an electrician. Does not use any regular medications. He has been referred for evaluation due to chronic pain in the right shoulder following a fall 2-3 months ago. He was examined by the emergency room after the injury, no fracture was detected. He now has pain and impaired function, particularly with overhead shoulder activity, and he cannot lie on the shoulder at night because of the pain.
- Explain how you would examine this patient to find out if he has an impingement syndrome.
Shoulder examination
- Perform standard shoulder examination (module 2.4)
- Inspection
- Active movement
- Passive movement
- Isometric movement
- Palpation
- Exclude instability in the shoulder
- Exclude rupture in the m. supraspinatus
- Perform Neer's test, Hawkins test, and O'Brien test
Shoulder instability
Shoulder hypermobility
Shoulder labrum injury
Shoulder impingement
Supraspinatus
Clinical findings
The patient indicates a pain arc during active elevation of the arm.
He has pain with isometric abduction when tested with the arm under 20 degrees abduction, and he has a positive empty can test.
What is wrong with the patient?
Painful arc with positive isometric abduction and positive empty can test indicates impingement of the M. supraspinatus.