Fig. 4.1
Neer’s impingement
4.2 Hawkins-Kennedy Impingement Test
This test is used to evaluate impingement of the subacromial bursa and rotator cuff. The test can be applied with the patient seated or standing. While the arm is in 90° forward flexion and the elbow bent at 90°, the scapula of the patient is stabilized with one hand, and with the other hand holding the forearm, it is forced into internal rotation (Fig. 4.2). The arm must not be taken into abduction during the test. Pain in the anterior shoulder during internal rotation indicates test positivity.
Fig. 4.2
Hawkins-Kennedy impingement test
4.3 Yocum Sign
Another test useful in the evaluation of rotator cuff impingement is the Yocum sign. In the test, the patient is told to put one hand on the opposite shoulder and raise the elbow (Fig. 4.3). Pain in the anterior shoulder and an increase in the symptoms of the patient indicate test positivity.
Fig. 4.3
Yocum sign
4.4 Coracoid Impingement Sign
The arm being examined is taken into abduction and anterior flexion toward the other side. Then the arm of the patient is forced into internal rotation (Fig. 4.4). Pain over the coracoid and limitation in internal rotation are accepted as positive for coracoid impingement syndrome.
Fig. 4.4
Coracoid impingement sign
4.5 Lift-Off Sign
This shows damage to the inferior section of the subscapularis muscle in particular. When the patient’s arm is positioned on the back, it is difficult to remove the hand from the back when in maximum internal rotation (Fig. 4.5).
Fig. 4.5
Lift-off sign
4.6 External Rotation Lag Sign
This test is used to show pathologies of the supraspinatus and infraspinatus muscles. The shoulder of the patient is held from the elbow with one hand. While the patient’s elbow is in 90° flexion, the shoulder is taken into external rotation with the other hand, and the patient is requested to hold this position (Fig. 4.6). If the patient cannot maintain external rotation, test positivity is shown.
Fig. 4.6
External rotation lag sign
4.7 Drop Sign
With the elbow in 90° flexion and the shoulder in 90° abduction, the shoulder is taken into external rotation and the patient is told to hold this position (Fig. 4.7). Pain and weakness which may cause the arm to fall indicate test positivity. The sensitivity and specificity of this test are very high for highly degenerated infraspinatus tears in particular.
Fig. 4.7
Drop sign
4.8 Speed Test
This test is used to evaluate pathologies of the proximal tendon of the long head of the biceps. With the elbow in extension and the forearm in supination, the shoulder of the patient is taken to 60° anterior flexion. Force is applied to the patient’s forearm to take it into extension (Fig. 4.8). Pain felt in the bicipital groove indicates biceps pathology.
