Episode 022-Most Popular Special Tests for the Shoulder! Evidence and Experience

In this “Episode 022-Most Popular Special Tests for the Shoulder! Evidence and Experience” I get to the meat and potatoes  about what special tests for the shoulder I like and what the majority of shoulder surgeons also like. I review some of the special tests and talk about diagnostic accuracy.  I also throw in my “two cents” about evidence and experience.

Episode 022-Most Popular Special Tests for the Shoulder! Evidence and Experience

I often get asked…What special tests do “you” like to use and “which” tests are the most accurate? Well, well, well! Totally loaded question that I hope to simplify for you.

I have learned through experience and with lots of trial and error how to most efficiently evaluate shoulder injuries. In college you learn a crazy number of “special tests” and I have found a handful to be very useful and accurate for certain diagnoses. Also, if you were to perform all of these tests in one sitting you would either eat up all of your evaluation time or kill the poor patient.

 

 

I’ve come across this very interesting study and absolutely love it! Here is the link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3396306/

In today’s Podcast I discuss the process I like to use when evaluating shoulders and talk about which tests have been most accurate when trying to “nail” a diagnosis. How do you assess your diagnostic accuracy? Maybe confirmation by an orthopedic surgeon or through diagnostic imaging.

Rules for evaluating shoulders

  • You have a “huge” mechanical advantage over your patient. Don’t cause any harm!! Remember your hand placement and always start with light pressure when ranging or manual muscle testing your patient.
  • Don’t forget to rule out the cervical spine
  • Think 3 dimensionally when evaluating the shoulder.
  • Don’t depend on special tests alone.
  • Know your anatomy!!!

 

 

 

 

Paul’s process for shoulder evaluations

  • Start with Cervical spine clearing! ??’s, DTR’s, sensation, distal MMT’ing and c-spine special tests.
  • I ask the patient to “put a finger on where it is sore”
  • MOI?
  • Palpate
  • AROM
  • PROM
  • MMT
  • Special tests- Pick most appropriate

 

Evidence vs Experience (ex. RCR)

  • Sciascia et al. Journal of AT 2012 did a nice article.
  • Surveyed 71 Members of the Amer. Shoulder and Elbow Society
  • 122 tests with 9 shoulder conditions
  • Only 20% of the tests were used.

 

Paul’s Favorites

  • Empty can, NEER, Hawkins-Kennedy
  • Apprehension and relocation
  • Jerk
  • Bear hug, belly press, lift-off, empty can
  • Cross body adduction
  • Speed’s test
  • O’Brien
  • Wall Push up

 

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In Good Health,

Paul Marquis PT

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