Supraspinatus shoulder assessment

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

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From the American Academy of Orthopedic Surgeons

The supraspinatus tendon is the tendon most often injured of the four tendons that constitute the rotator cuff.

Supraspinatus tendonitis is often associated with shoulder impingement syndrome.

Impingement (pinching) of the supraspinatus tendon leads to supraspinatus tendonitis (inflammation of the supraspinatus/rotator cuff tendon and tendinopathy (degeneration of the tendon).

The supraspinatus shoulder assessment consists of evaluating muscle strength as well as testing for signs of impingement.

The supraspinatus may be isolated by having the patient rotate the arm so that the thumbs are away from the floor and resistance is applied with the arms at 30° of forward flexion and 90° of abduction.

Note that pain is felt with tendonitis or partial injury to the supraspinatus tendon with the supraspinatus isolation test, but weakness can also be found accompanying partial- or full-thickness tear of the supraspinatus tendon. Also, weakness may be found with tendonitis because of muscle inhibition from the pain.

For the Neer test, the examiner forcefully elevates an internally rotated arm in the scapular plane, causing the supraspinatus tendon to be impinged against the anterior inferior acromion.

In the Hawkins-Kennedy test, the examiner forcefully internally rotates a 90° forwardly flexed arm, causing the supraspinatus tendon to be impinged against the coracoacromial ligamentous arch. Pain indicates impingement of the supraspinatus tendon. This is a positive impingement sign.

For the impingement test, the examiner injects 10 mL of a 1% lidocaine solution into the subacromial space and then repeats the tests for the impingement sign. Elimination or significant reduction of pain constitutes a positive impingement test result.

With the drop arm test, the patient places the arm in maximum elevation in the scapular plane and then lowers it slowly. The test can be repeated following subacromial injection of lidocaine. Sudden dropping of the arm indicates a possible rotator cuff tear.

With the supraspinatus isolation test/empty can test (Jobe test), the supraspinatus may be isolated by having the patient rotate the arm so that the thumbs are pointing to the floor and resistance is applied with the arms in 30° of forward flexion and 90° of abduction (simulates emptying of a can). The result is positive when weakness is present compared with the unaffected side, suggesting a tear of the supraspinatus tendon. Some authorities feel the supraspinatus may be more effectively tested with the thumb-up position (i.e., "full can") rather than the thumb-down position

In evaluating the rotator cuff, the patient's affected extremity should always be compared with the unaffected side to detect subtle differences in strength and motion. A key finding, particularly with rotator cuff problems, is pain accompanied by weakness. True weakness should be distinguished from weakness that is due to pain. A patient with subacromial bursitis with a tear of the rotator cuff often has objective rotator cuff weakness caused by pain when the arm is positioned in the arc of impingement. Conversely, the patient will have normal strength if the arm is not tested in abduction.

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