Special Diagnostic Tests for Shoulder Pain

Your physical therapist (PT) performs special tests for the shoulder to determine what problem may be causing your shoulder pain or limited motion. These tests can help your doctor or physical therapist decide on a diagnosis for your shoulder pain and can determine the best treatment for you.

Assessing Shoulder Pain

If you have shoulder pain or have injured your shoulder, your doctor may refer you to physical therapy to help you regain use of your arm. You may also be able to self-refer to physical therapy via direct access.

Your PT will perform various tests and measures to help determine the problem that may be causing your shoulder pain. Your therapist may measure your shoulder range of motion and strength. Your shoulder muscles may be palpated or touched, to help determine if there is any specific pain or tenderness around your shoulder.

Shoulder special tests may also be performed. These tests help your physical therapist determine if your shoulder pain is being caused by a muscle or tendon problem, shoulder impingement, or shoulder instability.

Below is a list of common special tests that your physical therapist may perform. If you have injured your shoulder, you most certainly should visit your doctor or physical therapist to help determine the cause of the problem and to get the proper treatment.

It should be noted that some shoulder special tests have poor reliability. That means that if two different physical therapists perform the same test, they may interpret the results differently.

Shoulder special tests give the examiner an idea of what may possibly be going wrong with your shoulder, but they don't give the entire picture. Your true diagnosis comes from your entire clinical exam, including special tests, and from diagnostic tests that your doctor may order to confirm suspected diagnoses for your shoulder.

Neer's Test

Patient explaining shoulder pain to doctor
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Neer's test is a special test for the shoulder that tests for shoulder impingement. It is a simple test that is performed by your physical therapist by lifting your shoulder up and then adding overpressure at the end of the range of motion.

Pain at this end range means that the test is positive and that impingement of the shoulder is likely causing your shoulder pain. The test doesn't tell which structure—the bursa, a ligament, or the rotator cuff, is being pinched in your shoulder. It merely tells you that something is being pinched.

One study found that a modified form of the Neer test has an accuracy rate of 90.59% for identifying subacromial impingement syndrome (SAIS).

Speed's Test

The biceps tendon resides in a groove in the front part of your upper arm, and pain here may indicate that you have biceps tendonitis. Speed's test is a shoulder special test for biceps tendonitis. Research suggests it has a sensitivity rate of about 63% and a specificity rate of about 58%.

Your physical therapist performs Speed's test by having you raise your arm until it is parallel to the floor. With your palm facing up, your physical therapist then pushes your arm down while you resist

Pain in the front part of your shoulder, while you are resisting the push from your therapist, may indicate that you have biceps tendonitis.

Apprehension and Relocation Test

If your physical therapist suspects that you have shoulder instability or a shoulder labrum tear, they might perform the apprehension test.

The test is performed with you lying on your back. Your physical therapist then bends your elbow to 90 degrees and moves your arm out to your side. The PT then rotates your shoulder so that the back of your hand moves towards the floor. This is called external rotation of the shoulder.

If you feel like your shoulder is about to pop out of joint, or if it actually pops out of joint, the test is positive. Of course, this position is likely to cause you apprehension, and thus the name of the test.

The relocation portion of the test is performed by having your physical therapist place one hand on top of your shoulder to help put the joint back into place. You should feel like the joint is in the right place, and your apprehension about having a dislocated shoulder will disappear.

Sulcus Test

If your PT suspects you have shoulder instability from a labrum tear, they may perform the sulcus test. To do this test, you simply hang your arm down at your side, and your PT then gently, but firmly, pulls down on your arm.

A positive sulcus sign is when a small divot, or sulcus, appears at the top of your shoulder joint. This means that your shoulder may be pulling away from the socket, indicating shoulder instability.

AC Joint Compression Test

The acromioclavicular (AC) joint is made up of the union of the collar bone and acromion portion of the shoulder blade. It is located on the top part of your shoulder.

The AC joint may become separated in a traumatic event like a sports injury or a car accident. If your physical therapist suspects that you have a separated AC joint, they may perform the AC joint compression test.

To perform the test, your PT places one hand on the front of your shoulder and one hand on the back of your shoulder. Your therapist then pushes their hands together, compressing the AC joint. If intense pain if felt, then the test is positive and an injury to the AC joint is suspected.

Hawkin's Kennedy Test

The Hawkin's Kennedy test is another test for shoulder impingement. It is performed by your physical therapist who raises your arm with your elbow bent about 90 degrees. The arm is then brought in front of the body, and your elbow is then raised up while your forearm is lowered.

Pain in the shoulder indicates that structures in the shoulder like the rotator cuff or the bursa are getting pinched.

Drop Arm Test

Your PT may perform the drop arm test if they suspect that you have a rotator cuff tear in your shoulder. The test is done by having your physical therapist lift your arm out to the side of your body while keeping your arm straight. Your therapist then drops your arm (hence the name of the test).

A positive test occurs when you are unable to hold your arm out to the side and it falls to your side. This means that you might have a rotator cuff tear in your shoulder.

Empty Can Test

The empty can test (also known as Jobe's test) is another test for the rotator cuff muscles, especially the supraspinatus muscle on the top part of the shoulder.

It is simple to perform. Just raise your arm out to the side, bring your arm forward about 6 to 8 inches, and turn your hand down, like you are pouring out a can of soda.

From this position, your physical therapist can gently push on your arm, and pain or weakness indicates a positive test for a possible supraspinatus tear or problem.

Tests for Frozen Shoulder

A frozen shoulder is a painful condition that involves a severe loss of range of motion in the shoulder coupled with significant pain. There really is no special test or diagnostic test, like an X-ray, for a frozen shoulder.

The diagnosis is made by observation of the mobility of your shoulder. Usually, a painful loss of motion while lifting your arm forward, out to the side, and through rotation indicates a frozen shoulder.

A Word From Verywell

If you have shoulder pain, you may benefit from visiting a PT to learn what may be causing your pain and to get on the path to recovery with the right treatment.

Shoulder special tests may be used by your physical therapist as part of the shoulder examination to determine the nature of your injury and what anatomical structures may be at fault. They are helpful in guiding the decision-making process of the shoulder examination.

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