If you have shoulder pain or have injured your shoulder, your doctor may refer you to physical therapy to help you regain use of your arm. You may also be able to self-refer to physical therapy via direct access.
Your physical therapist will perform various tests and measures to help determine the problem that may be causing your shoulder pain. He or she may measure your shoulder range of motion and strength. Your shoulder muscles may be palpated, or touched, to help determine if there is any specific pain or tenderness around your shoulder.
Shoulder special tests may also be performed. These tests help your physical therapist determine if your shoulder pain is being caused by a muscle or tendon problem, shoulder impingement, or shoulder instability.
Below is a list of common special tests that your physical therapist may perform. If you have injured your shoulder, you most certainly should visit your doctor or physical therapist to help determine the cause of the problem and to get the proper treatment.
1. Neer's Test
Neer's test is a special test for the shoulder that tests for shoulder impingement. It is a simple test that is performed by your physical therapist by lifting your shoulder up and then adding overpressure at the end of the range of motion. Pain at this end range means that the test is positive and that impingement of the shoulder is likely causing your shoulder pain.
The biceps tendon resides in a groove in the front part of your upper arm, and pain here may indicate that you have biceps tendonitis. Speed's test is a shoulder special test for biceps tendonitis.
Your physical therapist performs Speed's test by having you raise your arm until it is parallel to the floor. With your palm facing up, your physical therapist then pushes your arm down while you resist. Pain in the front part of your shoulder while you are resisting the push from your therapist may indicate that you have biceps tendonitis.
If your physical therapist suspects that you have shoulder instability or a shoulder labrum tear, he or she might perform the apprehension test.
The test is performed with you lying on your back. Your physical therapist then bends your elbow to 90 degrees and moves your arm out to your side. He or she then rotates your shoulder so that the back of your hand moves towards the floor. This is called external rotation of the shoulder. If you feel like your shoulder is about to pop out of joint, or if it actually pops out of 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 physical therapist 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, and your apprehension about having a dislocated shoulder will disappear.
The AC joint, or acromio-clavicular 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, and it may become separated in a traumatic event like a sports injury or a car accident.
If your physical therapist suspects that you have a separated AC joint, he or she may perform the AC joint compression test. It is performed by your physical therapist who places one hand on the front of your shoulder and one hand on the back of your shoulder. Your therapist then pushes his or her hands together, compressing the AC joint. If intense pain if felt, then the test is positive and an injury to the AC joint is suspected.
5. Hawkin's Kennedy Test
Hawkin's Kennedy test is another test for shoulder impingement. It is performed by your physical therapist who raises your arm with your elbow bent about 90 degrees. The arm is then brought in front of the body, and your elbow is then 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.
If your physical therapist suspects that you have a rotator cuff tear in your shoulder, he or she may perform the drop arm test. The test is done by having your physical therapist lift your arm out to the side of your body while keeping your arm straight. Your therapist then drops your arm (hence the name of the test). A positive test occurs when you are unable to hold your arm out to the side and it falls to your side. This means that you might have a rotator cuff tear in your shoulder.
The empty can 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 physical therapist can gently push on your arm, and pain or weakness indicates a positive test for a possible supraspinatus tear or problem.
A frozen shoulder is a painful condition that involves a severe loss of range of motion in the shoulder coupled with significant pain. There really is no special test or diagnostic test, like an x-ray, for a frozen shoulder. The diagnosis is made by observation of the mobility of your shoulder. Usually a painful loss of motion while lifting your arm forward, out to the side, and through rotation indicates a frozen shoulder.