Special Diagnostic Tests for Shoulder Pain

A doctor is examining a patient's shoulder while he lies on a table


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Shoulder pain is among the more common reasons for why people visit a healthcare provider. Pain, tenderness, and reduced range of motion in your shoulder can disrupt your daily life.

Your healthcare provider may use one or several special tests in order to pinpoint the problem. The Neer test, Crank test, and Speed's test are among these tests.

This article explains 12 of these specific tests used for shoulder pain. It will walk you through how these exams are performed and why they are used to identify the type of shoulder condition.

Cartoon diagram of the shoulder joint.


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Assessing Shoulder Pain

If you have shoulder pain, your healthcare provider will begin with a basic physical exam. They will ask you about your history of injuries, your pain level, and your lifestyle. These details about your pain and how it has changed over time will be used along with the tests to arrive at a diagnosis.

Different structures, including several joints, muscles, and tendons, make up your shoulder. Some basic tests that measure things like range of motion and muscle strength will likely be done first. They will help to find the general area of your shoulder that has been affected.

Special shoulder tests are then used to narrow down the possible causes and the most effective treatments. Your healthcare provider will then know a more precise cause of your pain, whether it be muscle or tendon problems, joint impingement, or shoulder instability.

Imaging tests like X-rays, MRIs, and ultrasounds likely will be used to look for damage to joints, bones, tendons, ligaments, and cartilage. These tests can also look for changes over time.

Recap

Shoulder pain has many possible causes. For this reason, there are quite a few tests used to check and see how bones, tendons, and specific parts of the shoulder are involved. Your healthcare provider will choose them based on what they learn from your medical history and an initial exam.

Neer Test

The Neer test is quite simple. It is designed to look for shoulder impingement. This is a type of rotator cuff injury that's common in young and middle-aged people.

Your healthcare provider will stand behind you with a hand atop the affected shoulder. You'll start with your arms down by your side. Your provider then rotates your arm inward so that your thumb faces backward and down. They next lift your arm straight up toward the sky.

This action reduces the space between your rotator cuff and the bone on top of your shoulder. The Neer test is positive if this motion causes pain. It won't tell you whether it's the bursa, a ligament, or the rotator cuff in your shoulder that is being pinched. It just tells you that something is.

One study found that a modified form of the Neer test has an accuracy rate of 90.6% for identifying subacromial impingement syndrome (SAIS).

Subacromial impingement syndrome (SAIS) happens when tendons in the rotator cuff are irritated within the joint space through which they pass. This space is beneath a part of your shoulder blade.

Speed's Test

Speed's test is a special test meant to identify tendonitis in your bicep. The bicep muscle has two tendons that connect it to the shoulder bone. It also has one to connect it with the radius bone in your forearm.

Overuse from activities like golf, tennis, and weight-lifting can cause tiny tears in these tendons. This often leads to tendonitis.

Your healthcare provider will begin the Speed's test by having you raise your arm until it is parallel to the floor. With your palm face-up, the provider will then push your arm down while you actively resist the force.

You may feel pain in the front part of your shoulder as you "push back" against the pressure. This may mean that you have biceps tendonitis.

Speed's test is used to diagnose biceps tendonitis. However, research suggests the test only finds about 63% of such cases. It also delivers a high rate of false-positive results.

Apprehension and Relocation Test

Shoulder instability is a condition that causes the shoulder to come loose and completely or partially dislocate. An apprehension test may be used if your healthcare provider thinks it may be the cause of your pain.

The test is performed as you lie face-up on an exam table. Your healthcare provider extends your arm straight out off of the table. They then bend your elbow by 90 degrees. In this pose, you'll look a bit like someone showing off their biceps.

The provider uses one hand to keep the shoulder still. They then gently pull your forearm toward the floor. This is called external rotation of the shoulder.

If you feel like your shoulder is about to pop out of its joint, or if it actually does pop out of the joint, the test is positive. This position is likely to cause you to feel a little apprehension, and thus the name of the test.

The relocation step of this test is done by having your provider place one hand on top of your shoulder to help put the joint back into place. You should then feel like the joint is in the right place.

Sulcus Test

If your healthcare provider suspects you have shoulder instability, they may also perform the sulcus test. To do this test, you simply hang your arm down by your side. Your provider takes hold of your wrist or elbow, then pulls the arm down.

What they are looking for is a small sunken spot, or sulcus, at the top of your shoulder joint. This means that your shoulder may be pulling away from the socket, and it suggests shoulder instability is the cause.

Recap

Specific tests for shoulder pain include the Neer test, used to look for a type of rotator cuff injury called impingement. Speed's test is used to check for biceps tendonitis. Other tests are meant to check for shoulder instability and dislocation.

AC Joint Compression Test

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

Separation of this AC joint can happen due to sports injury, auto accident, or other trauma. If your healthcare provider thinks you may have a separated AC joint, they will likely do an AC joint compression test.

For this test, your provider will place one hand on the front of your shoulder and the other on the back of your shoulder. They then push their hands together to compress the AC joint.

If you experience pain, then the test is positive and an injury to the AC joint is suspected.

Hawkins-Kennedy Test

The Hawkins-Kennedy test is another test for shoulder impingement. Your healthcare provider raises your arm with your elbow bent about 90 degrees. The arm is then brought in front of the body, with the elbow raised as your forearm is lowered.

Pain in the shoulder points to a rotator cuff, bursa, or other structure that's getting pinched.

Drop Arm Test

Your healthcare provider may perform the drop arm test if they think you may have a rotator cuff tear in your shoulder. For this test, the provider will lift your arm out to the side of your body while keeping it straight. They then drop your arm (hence the name of the test).

The test is positive if you can't hold your arm up and it falls to your side. This means that you might have a rotator cuff tear in your shoulder.

Empty Can Test

Physical therapist rotating a patient's arm.

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The empty can test is also known as the Jobe test. It is used as a test of the rotator cuff muscles, especially the supraspinatus muscle on the top part of the shoulder.

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

From this position, your healthcare provider will gently push on your arm. Pain or weakness indicates a positive test for a possible supraspinatus tear or problem.

Recap

Traumatic injuries can lead to shoulder separation. A special diagnostic test is used to see if the AC joint is involved. The Drop Arm test and the Empty Can (Jobe) test may be used to diagnose a rotator cuff tear or its specific type.

Tests for Frozen Shoulder

A frozen shoulder is defined by a severe loss of range of motion in a quite painful shoulder. Usually, the pain happens when you lift your arm up or out to the side.

There are no diagnostic tests for frozen shoulder. A healthcare provider makes the diagnosis simply by observing how well (or not) you can move the shoulder.

Lift-Off Test

Patient lying prone on an exam table with his hand resting on the small of his back.


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Your healthcare provider may perform a lift-off test if they suspect a tear in the subscapularis tendon at your shoulder blade. You'll reach your hand around to rest on your lower back with your palm facing out.

You'll next try to move your hand away from your back. The provider may push your hand back to see how you handle the resistance. If this motion is hard or causes pain, then your test is positive for this type of tear.

Crank Test

The Crank test is used to identify a labral tear. This is a common injury in athletes who perform repetitive motions.

Your healthcare provider will hold your arm and bend your elbow 90 degrees. With one hand on your shoulder, they will grasp your elbow and rotate the arm back and forth. This test is positive if it causes pain or any odd clicking or clunking sounds in the shoulder.

Teres Minor Test

This test evaluates the teres minor tendon, one of the major shoulder tendons. Your healthcare provider will ask you to put your arms down by your side. You'll then lift your hand up so your elbows are bent to 90 degrees, as if you're doing a bicep curl.

With your elbows bent, you will move your hand backwards while the provider pushes back for resistance. Any pain or weakness suggests a teres minor injury.

Recap

Other tests for shoulder pain include the Teres Minor test for the possibility of a torn tendon, and the Crank test used to identify a labral tear common to athletes. There is no specific test used to diagnose a frozen shoulder.

Summary


Specific tests for shoulder pain are used to pinpoint the exact cause among many possibilities. After talking with you about your pain and doing a basic exam, your healthcare provider may choose one or more of these tests.

Exams like the Neer test or Crank test will give them a more precise idea of the reason for your pain. Other tests, like X-rays or an MRI, may help to confirm a diagnosis.

Once the source of your shoulder pain is identified, your healthcare provider will recommend further treatment and set you on the road to recovery.

Frequently Asked Questions

  • How is a shoulder injury assessed?

    A shoulder injury is assessed with a combination of physical tests and imaging studies. Your health care provider will ask questions about your pain and move your arm in different ways to test your range of motion to pinpoint the problem.

    Sometimes, physical tests are enough for the doctor to make a diagnosis, while imaging studies, such as X-ray, ultrasound, or MRI, are often needed to confirm a diagnosis.

  • What physical tests are used to assess shoulder pain?

    Physical tests your health care provider may perform to examine your shoulder include: 

    • AC joint compression test
    • Apprehension and relocation test
    • Crank test
    • Drop arm test
    • Empty can or Jobe test
    • Hawkins-Kennedy test
    • Lift-off test
    • Neer test
    • Speed’s test
    • Sulcus test
    • Teres minor test

    These tests involve the healthcare provider placing your arm in different positions and then asking you to move the arm in a certain way.

  • What special tests are used to evaluate the rotator cuff?

    Three physical tests used to identify a rotator cuff injury include the drop arm test, empty can test, and Neer test. 

    A more invasive test is known as the pain-relief test. In this, an orthopedic specialist injects lidocaine into the shoulder joint. If the shot relieves the pain, it is likely the rotator cuff. 

    Imaging tests to evaluate a rotator cuff include MRI, arthrogram, and ultrasound. 

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