Special Diagnostic Tests for Shoulder Pain

Shoulder pain is among the more common reasons people visit their healthcare provider. Pain, tenderness, and reduced range of motion in your shoulder can be extremely troublesome. A shoulder injury can not only take you away from your normal work and fitness routines, it can affect your ability to perform simple tasks like washing your hair and getting dressed.

Many things can disrupt the normal function of your shoulder, so it is important to get an accurate diagnosis. To pinpoint the problem, your healthcare provider may employ a variety of specialized shoulder tests. This may include Neer's test, Speed's test, an apprehension test, the Hawkins-Kennedy test, the empty can test, and others.

Assessing Shoulder Pain

If you have shoulder pain, your healthcare provider will conduct a basic clinical exam. They will ask you about your history of injuries, your pain level, and your lifestyle. To help make a diagnosis, your healthcare provider needs to understand how and when your pain began and how it has progressed over time. These details are just as important as testing.

The shoulder is comprised of many different structures, including several joints, muscles, and tendons. Your healthcare provider may conduct several basic tests to figure out which general area of the shoulder has been affected. These tests measure things like range of motion and muscle strength.

Cartoon diagram of the shoulder joint.


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Special shoulder tests help healthcare providers further pinpoint the precise cause of your pain, whether it be muscle or tendon problems, joint impingement, or shoulder instability. The purpose of these tests is to aid the diagnostic process and identify the most effective treatments.

Imaging

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

Neer's Test

Neer's test is a special test that looks for shoulder impingement, which is a type of rotator cuff injury common in young and middle-aged people. Neer's test is quite simple. Your healthcare provider will stand behind you with a hand on the top of the affected shoulder. Starting with your arms down by your side, your practitioner will rotate your arm inward so that your thumb is facing backwards/down. They will then 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 test is considered positive if this motion causes 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

Speed's test is a special test that helps identify tendonitis in the bicep. The bicep muscle has two tendons connecting it to the shoulder bones and one connecting it to the radius bone in your forearm. Overuse from activities like golf, tennis, and weight-lifting can cause tiny tears in these tendons, resulting in tendonitis.

Your healthcare provider performs Speed's test by having you raise your arm until it is parallel to the floor. With your palm facing up, your practitioner then pushes your arm down while you resist. Pain in the front part of your shoulder, while you are resisting the push from your practitioner, may indicate that you have biceps tendonitis.

Research has found that this test only detects about 63% of biceps tendonitis cases. It also has a high likelihood of producing a false-positive result.

Apprehension and Relocation Test

If your healthcare provider suspects that you have shoulder instability, a condition that causes the shoulder to come loose and completely or partially dislocate, they might perform the apprehension test.

The test is performed with you lying 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, so that you look like someone showing off their biceps. While stabilizing your shoulder with one hand, your healthcare provider then gently pulls 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 pops out of the 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 healthcare provider 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.

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. Taking hold of your wrist or elbow, your practitioner pulls the arm down.

Your healthcare provider is looking for the appearance of a small divot, or sulcus, 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 healthcare provider suspects that you have a separated AC joint, they may perform the AC joint compression test.

To perform the test, your practitioner places one hand on the front of your shoulder and one hand on the back of your shoulder. They then push their hands together, compressing 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, and your elbow is 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 healthcare provider 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 practitioner lift your arm out to the side of your body while keeping your arm straight. They then drop your arm (hence the name of the test).

A positive test occurs when you are unable to 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.

Aldo Murillo / Getty Images

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 healthcare provider can gently push on your arm. 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. Usually, a painful loss of motion while lifting your arm up or out to the side indicates a frozen shoulder. There are no diagnostic tests for frozen shoulder. The diagnosis is made by observation of the mobility of your shoulder.

Lift-Off Test

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


Emir Memedovski / Getty Images

Your healthcare provider may perform a lift-off test if they suspect a tear in the subscapularis tendon. Your practitioner will ask you to reach your hand around to rest on your lower back, with your palm facing outward. You will then try to move your hand away from your back. Your healthcare provider may push your hand toward your back to see how you handle the resistance. If this action is difficult or painful for you, the test is considered positive for a subscapularis tendon tear.

Crank's Test

Crank's test is another method for identifying a labral tear, which is common in athletes who perform repetitive motions. The examiner will hold your arm and passively bend your elbow 90 degrees. Leaving one hand on your shoulder, the examiner will grasp your elbow and rotate the arm back and forth. This test is considered positive if it is painful or if it causes the shoulder to make strange sounds.

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 then lift your hand up so your elbows are bent to 90 degrees (like you would do during a bicep curl). Keeping your elbows bent, you will move your hand backwards while the practitioner pushes for resistance. Any pain or weakness suggests a teres minor injury.

A Word From Verywell

If you have shoulder pain, you may benefit from visiting a healthcare provider or a physical therapist. They can help uncover the cause of your pain and get you on the path to recovery. With the right diagnosis, treatment is very effective.

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10 Sources
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