Shoulder Impingement Assessment

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Assessment of shoulder impingement aims to identify which structures are causing pain.

Pain in the shoulder can be coming from a number of structures. To help determine the cause of pain, a therapist will perform an assessment. This usually consists of a subjective assessment where the patient is asked questions conerning the injury and their medical history, and an objective assessment where the therapist examines the injury.

Observation

  • The therapist will examine the shoulder, looking for swelling, bruising, muscle wasting, postural issues etc. It is important that the injured side is compared to the unaffected side at all times.

Palpation

  • The therapist will feel all around the shoulder, asking if there are any painful points and also feeling for muscular tightness and changes in skin temperature/texture.

Range of motion

  • The therapist will test the range of motion at the shoulder, both actively (the patient moves themselves) and passively (the therapist moves the arm and the patient relaxes). This should always be compared to the uninjured side for what is normal for each individual, but also compared to 'normal' guidelines.

Resisted muscle tests

  • The therapist will ask you to move your shoulder against resistance (usually provided by them pushing against you). Weakness compared to the uninjured side or pain during shoulder rotation or abduction indicates injury to the rotator cuff, which may be due to impingement

Special tests

There are a range of tests which can be performed which are used to indicate certain injuries:

Empty Can Test

  • You will be asked to put your arm out in front of you at a 45 degree angle to your body, with the thumb pointing to the floor (as if holding an empty can). The therapist will ask you to raise your arm whilst they resist your movement. This tests the Supraspinatus tendon.

Neer’s Sign

  • The therapist will position your arm with the thumb facing down and at a 45 degree angle to your body. They will then lift your arm up, above your head. If you experience pain or discomfort, you may have an impingement of supraspinatus.

Hawkins-Kennedy Test

  • Your arm will be raised in front of you to 90° and the elbow bent. The therapist will then medially rotate (turn the wrist down and elbow up) the arm. If this causes pain you probably have an impingement of Supraspinatus.
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