Q: What will my shoulder examination look like?

There are multiple diagnosis that can come from an examination of the shoulder. This is due to the complexity of the shoulder and multiple components that allow us to use our shoulder in the manner we do. Therefore, to better treat subacromial impingemnt syndrome (SIS), a proper diagnosis should be confirmed through examination.

Examination of the shoulder starts with a subjective history taking of the pain and functional deficits. Patient's with primary SIS generally present with pain at night, pain with overhead activities, and complaints of stiffness. Patient's with secondary SIS are typically of younger age, present with history of instability, pain with overhead activities, and/or are an overhead athlete.(1) When this subjective information is taken down this will help confirm SIS is present with objective physical examination.

Due to the multiple diagnosis that can come from the shoulder there are multiple tests that can be conducted. If SIS is suspected there are certain test that should be performed. With each examination a postural assessment, shoulder range of motion, and muscle strength should be taken. Possible special tests for SIS that can be used are as follows: Neer sign, Hawkins-Kennedy sign, painful arc sign, supraspinatus test, speed test, cross-body adduction test, drop-arm test, and infraspinatus test. It has been noted though by Park et al. that if three of these test (Hakwins-Kennedy sign, painful arc, and infraspinatus test) are positive then there is post test probability of high value (95%) that impingement is present. (2) Another study by Bang et al. indicated there were five test that should be performed: Hawkins-Kennedy sign, Neer sign, painful arc, supraspinatus test, infraspinatus test. If 3 or more of these test were positive then the likelihood of SIS being present increases. (3) It was also noted in this same study that the most reliable single test are painful arc, external rotation or infraspinatus test, and empty can or supraspinatus test.

Bottom Line

When undergoing an evaluation and examination of the shoulder for possible SIS there are varying ways to help rule in or rule out SIS. When SIS is suspected the following should be included to increase the likelihood of proper diagnosis and treatment:

• Detailed subjective history
• Postural assessment
• Range of motion
• Manual muscle testing (MMT)
• Special test:
  • Hawkins-Kennedy sign
  • Neer Sign
  • Painful arc (can be assessed during range of motion)
  • Infraspinatus or external rotation testing
  • Supraspinatus or empty can testing

1. Robertson, E. Current best evidence for the diagnosis and treatment of subacromial impingement syndrome. Lecture. Evidence in Motion. 2011.
2. Park HB, Yokota A, Gill HS, et al. Diagnostic Accuracy of Clinical Tests for the Different Degrees of Subacromial Impingment Syndrome. Journal of Bone and Joint Surgery. July 2005; 87-A; 7; 1446-1455
3. Michener LA, Walsworth MK, Doukas WC, et al. Reliability and Diagnostic Accuracy of 5 Phyiscal Examination Test and Combination Tests for Subacromial Impingement. Arch Phys Med Rehabil 2009;