- ♪ Bob and Brad ♪
♪ The two most famous ♪
♪ physical therapists ♪
♪ on the internet. ♪
- Hi, folks, I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- And we are the most famous physical therapists
on the internet.
- In our opinion, of course, Bob.
- Today for your viewing pleasure
we're gonna show you five best tests for
supraspinatus shoulder impingement.
So that is the most common muscle and tendon
to be impinged, isn't it?
- In the shoulder.
- Yeah, in the shoulder.
- Right.
Yeah, it's the most common ...
I like to call the idiopathic cause because
this is one of those shoulder things where
often times you don't really know why it happens
It happens over cumulative ... it's not like you fell down.
- Funny you just said that because
I just had friend that said, "Yeah, my sister saw your
videos" and it's like "I don't know how she hurt her
shoulder, it just started hurting."
- Yeah.
- So I'm like, I'm sure it's an impingement.
- Sure.
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Anyways, Bob, should we get on with the show?
Yeah, let's get on with the show.
- Okay, so
impingement,
like we mentioned, let's just go
briefly with Sam,
where the impingement, like the name says, impinged.
Things are getting pinched.
- Yep.
- There you go.
So, which shoulder should we use?
- Well, you got the blue on there.
- There you go.
So here's the supraspinatus tendon.
- [Bob] That's the one we're talking about.
The muscle starts actually up here
- Right
- [Bob] and fills in this little trough.
- And then there's a little tunnel right thorough here,
if I can get the pen to go through there.
It goes right through there and then
it's part of what lifts your shoulder up.
- Right, especially out to the side.
- Right and then once you get up to the higher range
it doesn't work so much and then the big deltoids take over.
- I think you can see how it could get pinched.
- Right, so right there, the blue representing that
now, see that gap in there pinching.
Now if the rotator cuff is working properly
and everything is mechanically right, what happens
is the humeral head drops down and
creates a gap and allows that.
Sam doesn't allow me to have that because they made
these tendons pretty taut.
- And what can lead to this is often poor posture.
- Right.
- Lotta that forward head posture and rounded shoulders.
- Right.
- So, just as ... you'll have to watch some of our videos
how to treat supraspinatus tendonitis, but right now we're
just gonna show how to try to help you diagnose it.
- Right.
- How to assess it.
- So we've got five relatively simple tests you can do,
pretty much by yourself.
- Excellent.
- The first one is just actually palpate
or see if it's sore.
Now one little trick is you can take the back of your palm
and put it right there on your greater trochanter, your hip,
right by your pocket there.
And then you go up here and you're gonna find that,
well let's show here--
- I'm glad that you said packet, you mean pocket?
- Pocket.
- Well, I thought you were gonna say package
and I'm like, I don't wanna ...
This is a family show, Brad.
- Where is your head, Bob?
- I'm just sayin'.
- Bob, so you look at this bone right here, the acromion.
That bone, most people can find it, there's no muscle on it.
So it's just a bony part there and then you go down from
there into the meat just a little bit and then you're pretty
much on that supraspinatus tendon.
And a nice thing to do is do it the other side
and compare one side to the other.
- And sometimes they both can be tender.
- Sure.
- But generally, if you're having more pain on one shoulder,
it will be more tender.
- Right, right.
Now the next one is the Neer's test.
I always remember this because Neer to the ear.
- Oh, cool.
- Yeah, so you're gonna take your hand
and you're gonna go in the sagittal plane.
So straight up in front of you,
not out to the side or over here, straight up in front.
But I want you to turn your palm so it's down like this
and then you're gonna go up ...
Now this one you take your other hand
and you're gonna try and do it passively.
So you're not gonna lift it up, passively lift it up,
thumb down--
- So this arm is doing the work.
- Exactly, yeah, we're testing the right arm.
Once you get up past ninety degrees,
up in the 120 degree range, if you feel some pain
and it starts to hurt right up in here,
that's that impingement going on
that we showed you with Sam.
You know, you can do it with the other hand.
Now, you can have someone else do the passive range for you.
And that does work a little bit better and then you can
go to one side and go over--
- And it's funny cause I had an impingement on this side,
I just feel it just a little bit yet.
- Even when I go way--
- Ah, not too bad, no.
- Okay, so he's got a negative sign.
If you can go that high and it's that painful,
that's negative.
Then we'll go to Hawkins.
Now, this one I call Hawkins-Kennedy.
I took a class by this shoulder guru,
he just called it Hawkins, so, but it's the same test.
Now, this one you're gonna take your elbow
in the sagittal plane, straight up in front of you.
To that ninety degree, put your palm like this,
and then bend your elbow in towards you.
So you're looking like this.
- So up, flat, palm down.
- Yep, and then over.
Now, if you think of your elbow being the pivot point,
it's not gonna move and then you're gonna rotate in.
So you can take your other hand and
put a gentle pressure down.
And you'll feel impingement, some pain right there.
- Now, when I do this to my patients, this is how
I grab here, here, and then I go down like this
and then I say, "let's do the other arm"
and then we compare.
And actually bring that right, there you go.
Like that.
- Again, I feel just a tinge on that side.
- Okay, so that's the Hawkins.
And now this is the one that--
- Shall not be named at this time.
- Shall not be ... there's some controversy on the name
but it's a very simple one you can do all by yourself.
- Right, it's wonderful.
- If I'm gonna test my right shoulder,
my right palm goes on my left shoulder.
Take my other hand and just go, while you maintain contact
with this hand, go up like this to about ninety degrees,
or shoulder level.
Okay, then you're gonna test the other one.
And again, a positive sign is, "oh, it hurts."
- I keep untucking my shirt. (laughs)
- Bob, look at this, we gotta fix this.
Get that behind your ear.
- There we go.
- Sorry about that.
We didn't primp enough I guess.
- I didn't attach this right.
- Don't worry about it, Bob, you look fine.
And now this is the standard, classic, empty can test.
And you're gonna take your arms like this,
and then go forty five degrees forward,
thumbs pointed down,
and I'm gonna say do one hand.
Start with the right hand,
or the left, whichever one you want.
And you're go up, that's called the sagittal plane.
Okay, and as you go up, when you get up to about
usually eighty degrees, ninety degrees,
you'll start to feel some pain there.
If you wanna reach over and push down
and it hurts more with that,
that'd be even more positive.
And then test the other side.
Again, it's not straight in front of you
like the other tests.
Or straight out to the side,
it's in that scaption range of--
- I was gonna say, more scapular plane, not sagittal.
- Right, so it's scaption.
- Yep.
- So and then we're gonna go up.
Why'd you look at me like that, Liz?
(laughs)
- Cause you said sagittal.
- She concurs.
- You said sagittal the first time.
- Well, darn it anyway.
Caught again!
This is why we help each other.
- Yeah, that's right.
- So there's five tests.
Now, you might be positive or semi-positive,
but if you're like a real strong positive,
and you have a hard time reaching up--
- Again, positive means it actually hurts when you do these.
- Right.
- If you're positive on all five,
you probably have impingement.
- I was positive probably on three of them,
and again, I just have the slightest ...
I don't even notice it during the day now.
- You're positives, if I was writing this down,
I'd say semi-positive cause they weren't really strong.
- Right.
- So it takes a little practice,
but we're doing the best we can to help you out.
- So if you decide you do have it,
go ahead and watch our other videos,
just type in "Bob and Brad's supraspinatus impingement" or
shoulder impingement and we're gonna give you
some great exercises to do for yourself.
- You better believe it.
- Alright, remember we can fix just about anything,
- Except for
- A broken heart.
- Are you gonna put it up there cause I watched a video once
and there was no heart floating on--
- Oh, wasn't there?
- Yeah.
- Liz, put a heart there.
Alright, thanks for watching.