This is Brent of the Brookbush Institute, and in
this video we're going to go over two special,
or orthopedic tests for the shoulder
that are indicative of either
impingement or rotator cuff damage. I'm
going to have my friend, Melissa, come out.
She's going to help me demonstrate these
tests. The reason we've paired these
tests is I think you're going to find
they look very similar to the Kendall
manual muscle tests we've gone over in
previous videos. The first one is
actually called the Internal Rotation
Resisted Strength Test. I'm going to have
Melissa go ahead and bring her shoulder
into 90 degrees, her elbow in 90
degrees of flexion, and her wrist is
going to be in neutral. I'm going to
brace her elbow a little bit here. I'm
going to go ahead and put my hand behind
her hand and have her press back into my
hand to externally rotate the shoulder.
I'm not going to try to overpower her. I'm
just going to match her strength. Press
as hard as you can, Come on, come on.
Alight, you don't have to actually egg
people on, but you do want to take mental
note of how strong she is in external
rotation. Now, I'm going to do the same in
internal rotation. Alright, go ahead and
press into my hand. Good. Good. And what I
want to note is: Are they about equal? If
internal rotation is weaker than
external rotation, that is indicative of
either a rotator cuff problem or
impingement. Of course, the other sign
that we always go back to is- go ahead
and press in- "Does this replicate the
symptoms you were talking about?" Always
remember to ask that question. So,
pain and/or weakness in internal
rotation when compared to external
rotation is a positive result for that
test. Now, the other test we're going to
do looks exactly like the manual muscle
test for external rotation. I'm going to go ahead and
brace her elbow hit a little bit here. I
want to make sure I show her what I'm
doing, what we want her to do. So, "Go ahead
and turn your hand out this way." Because
what you'll find is if you guys go, "Just
press out," people tend to do that old
school like deltoid machine thing. We
want to test external
rotation here. So, "Go ahead and externally
rotate. Does that hurt? Does that provoke
the symptoms you're talking about?"
So, if it's pain or if I know some
real significant weakness she may be- "Go
ahead press out"- if she just gives way under
a little bit of pressure, that's a
positive sign for this test. Alright,
guys, so, we have two tests here. We have
the Internal Rotation Resisted Strength
Test, and then we have the Infraspinatus,
or External Rotation Resistance Test.
Both of these tests can be used for
either rotator cuffs or impingement. We
do have to keep in mind that these
probably should be used within testing
clusters, because what I'm about to tell
you is going to be a little confusing.
These tests actually have higher
specificity than some of the other tests
we've already talked about, like the Neer,
or the Hawkins Kennedy, or the Yocum, or
even the Supine Impingement Test.
These tests tend to be more specific
than sensitive, which makes absolutely no
sense to me. We have tests that-
obviously, if they're testing for
impingement, why are we rotating and
testing the strength of our rotator cuff?
So, this is already bringing in more
diagnosis, making it a more specific test.
Ah, fun with research. Guys, if you weren't
confused about specificity and
sensitivity before, you probably are now.
That's okay, because sometimes it
doesn't work out mathematically as it
should. Let's start thinking through this
logically though. Obviously, moving,
resisting, resistance- using our strength
in this position- for somebody with
shoulder impingement is not going to
feel very good. We already have
some external rotation and some
abduction that's probably already
starting to compress on some of those
subacromial tissues. In this position,
external rotation, if somebody has pain
in this position, they're probably pretty
far along
in that impingement syndrome. They're
probably really, really inflamed. Also,
keep in mind that if we have a rotator
cuff tear- let's say we have a
subscapularis tear- is this going
to hurt? Yeah, yeah that's going to hurt a
lot. If we have a supraspinatus or an
infraspinatus tear, is this going to
hurt? Sure. So, how do we differentiate
between impingement and rotator cuff tear?
Well, we're going to have to think about
our subjective examination, realizing
that ruptures and tears are usually
acute. They usually happen with some sort
of incident that happened rapidly.
They're usually not chronic- not that
they can't be. If this was a
gradual onset, I might be thinking more
towards impingement, whereas if this was a
sudden onset, I might be thinking more
towards rotator cuff, or maybe if they
had a history of rotator cuffs. And then,
of course, we have to start adding all of
our other test results to this. So, if
let's say I do some other rotator cuff
tests and they come back negative, but I
do a bunch of impingement tests and they
all come back positive, then these two
tests probably help us solidify our
impingement hypothesis, as opposed to
solidify a rotator cuff hypothesis. Now,
how would I use this? Of course, I would
use this within a testing cluster, and I
would be looking for the concordant
sign, which I keep talking to you guys
about. You want to find your quick tests.
We're all short on time. So, as you're
going through your tests and find the one that
immediately provokes their symptoms, man,
you want to make note of that, because
when they come to the next time, that's
the one you're going to go back to. You're
not going to go through your whole
battery of tests again. You're going to
go back to that one provocative test, and
then that's the one you're going to keep
going back to as you test different
interventions. So, maybe I want to release
a few things and then see how that works,
test my hypothesis. Maybe I then want
to activate a few things, test my
hypothesis. Maybe I want to try something a
little bit more outside of the box,
although I know us movement
professionals think in this way. Maybe I
want to try some thoracic spine
mobilization or manipulation, thinking
that maybe scapular dyskinesis is
contributing to shoulder instability and
see if that improves. Well, I now have-
let's say this is her concordant sign-
I now have a quick test that I can
keep coming back to after each
intervention. We are going to be talking
about those testing clusters in
future videos. Please stay tuned. Let me
give you guys a quick review here of
these two tests. I hope you guys will
keep watching. So, starting with the
Internal Rotation Resistance Test: I'm
going to go ahead and bring her arm up
to 90 degrees of abduction, elbow 90
degrees of flexion, and wrist neutral. The big
sign on this test is internal rotation
weaker than external rotation. That
should make sense to you guys from a
kinesiology standpoint. Your internal
rotators are much bigger and stronger. So,
if your internal rotation rotators are
testing weaker than your external
rotators, that's an issue. We go ahead and
test external rotation first. Alright,
that feels pretty strong. We test internal
rotation. That's also pretty strong, so that's a
negative test, unless it happened to- "Did
that provoke your symptoms?" Oh, it did
provoke her symptoms. Well, then that's a
positive, actually. That's still a
positive test. I want to remember
that for my future quick tests. Again, the
External Rotation Test looks exactly
like that Kendall MMT. I'm going to go
ahead and brace her elbow here a
little bit, hold her elbow and make sure she's
not doing the old-school deltoid
exercise here. Go ahead and press out
in external rotation. She's very, very
strong, so I'm not getting any indication
there. "Does that provoke your symptoms?"
Yes, oh, that provokes her symptoms, so we
have some some serious issues here
having to do with either impingement or
rotator cuff, and I need to continue
testing. Guys, I hope you will continue to
learn your assessments. If you're not
assessing, your guessing. Step up your
assessment game
and continue watching these videos