- Hi, I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- And together we are the most famous physical therapists
on the internet.
- In our opinion, of course, Bob.
- Brad, I get a lot of questions
on impingement and whether or not people...
They, of course, want to know how to treat it.
But a lot of times,
I think people really don't have an impingement,
and they think they do,
that's why I thought,
let's go over some of the tests that we might do
to see if someone has an impingement.
Some of these,
you might even be able to try yourself,
and even have someone try it on you.
And we'll show 'em to you and you can decide.
- So we're talking shoulder pain?
- Yeah, shoulder pain, kind of a pinching.
We're gonna show at the end of the video
what we mean by that anatomically.
But I want to get right into the test.
All right, first one, Brad,
very simple one to do.
This is the most simple one,
is, take your hand,
let's say you're gonna test the right shoulder.
You're gonna grab the left shoulder.
And sometimes you're gonna get pain with that.
But that's more at the end of your collar bone probably.
And you lift the elbow up.
Okay?
Now, Brad's had a little shoulder pain here,
so we're gonna kind of see if any of these hurt.
Now, the other one, you take the left arm,
if you wanna test the left arm and grab the right shoulder,
and then lift up.
Now, it's your left shoulder that's giving you troubles
right, Brad?
- Right.
- Okay, no problems with any of this?
- No.
- Okay.
- So on this, it's positive,
typically when they lift up-
- It's gonna hurt when you lift up.
(Brad wails)
And positive does not mean good.
Positive means that you might have an impingement.
(hand slaps)
People sometimes get that positive, negative wrong.
Okay, second's test is called the Hawkins-Kennedy test.
And this is one, it would be better if you had someone
that could do it with you.
All right, face the camera, Brad.
So you're gonna bring up the arm to about 90 degrees.
Okay?
And I actually...
I don't have it way back here,
I have it a little bit forward.
This is called the plane of the scaffold,
you don't need to know that.
But you bend the elbow to a right angle.
See how that's at a right angle?
Okay.
So it's up to level, arm at a right angle.
Now I'm gonna bend it down a little bit here,
and I'ma bring it across.
- And he's supporting the elbow here.
- Yeah.
I'm bringing it across.
If there's pain when I bring it across,
little click in there.
- Yeah.
- But no pain on you?
- No problem.
- Okay, let's show on the other side.
So again, I bring the arm up, not,
a little bit forward.
So it's at a level,
bend the elbow to 90, a right angle,
bring it down and then bring it across.
Good posture, Brad.
No pain?
And this is his problematic shoulder.
- It's a little uncomfortable,
but there's no pain.
I would not call it a positive.
- Little more uncomfortable than this side?
- Yeah.
- Okay.
All right, next one, Neer's test.
These are all named after people,
Kennedy-Hawkins, Hawkins-Kennedy, Neer.
All right, this one,
you're gonna kind of hold down on the shoulder blade,
and you're gonna turn the arm.
So kind of thumb this way.
Not down, but you can just at least go to the inside.
- Not up?
- Yep.
And then we're just gonna bring the arm straight up,
and if it's gonna hurt,
it's gonna start hurting around here, Brad.
- And if it's positive,
they're gonna go, "Ah, ow."
- Yeah, it's gonna start hurting.
So we go on this side.
- Why don't you show 'em that hand placement on the back?
- Okay, yeah.
All I'm doing is holding the shoulder blade down.
- Right there, yeah.
- Okay, nothing magical.
So I'm holding the shoulder blade down,
gonna turn the thumb in a little bit here,
gonna bring it up, real simple one to do.
Anything on this one, Brad?
- Nope, that's fine.
- Okay.
I'm gonna show you one bonus one.
This is difficult to do,
but this one is considered 97% accurate.
So it's probably one of the most accurate tests
you could do for impingement.
Should we do your bad shoulder first or your good one?
- Let's do the good one.
- All right, let's do the good one.
(pillow thuds)
Lay down.
- And this one is a little more complicated.
- It is more complicated,
it's kind of hard to understand.
The first thing you're gonna do,
is you're gonna turn the hand,
palm up and the thumb as far over as you can go this way.
Does that make sense?
This is external rotation.
So we're pointing the thumb to the floor even if you can't.
And now I'ma bring the arm up,
I'm gonna grab the elbow,
the elbow is straight.
Bringing the arm up all the way up here.
And now I'm gonna bring it over to his ear.
Now, once it's over to his ear here,
now, I'm gonna turn the hand the other way.
Brad, anything?
- Nope, it's okay.
- Okay, so it was this way,
the thumb was down.
Now, I'm turning the thumb up,
and that's called external rotation.
So that one, he has no pain on it,
so that's negative.
Negative is good in the medical terminology.
(pillow thuds)
- Yep, when you're doing a test,
negative means
be happy.
- All right, so same thing again,
we're taking the hand,
we're putting it palm up,
the thumb is actually even maybe pushing down
to the floor a little bit,
I'm holding that out there.
I'm gonna straighten the elbow,
bring it all the way up.
(Brad wails)
Starting to feel it?
- Yep.
- Okay.
- See, I'm arching my back 'cause it's not-
- Now, I'ma bring it over,
over to the ear.
And now I'm gonna turn the hand the other way.
Any pain?
- That's not too bad but it's not fun.
- So he might have a slight positive here.
All right, you're gonna live, Brad.
All right, let's show 'em real quickly, Brad,
what we're talking about with an impingement here.
(metal rattling)
We got our arm, Brad?
- [Brad] Yeah.
- [Bob] Napoleon.
- [Brad] If you don't have an arm,
you don't have impingement or shoulder, I should say.
- [Bob] All right, so the shoulder joint is a ball,
and this is the socket.
And the places where you actually get pinching on,
is right here under the acromion and this red thing here,
we use that to represent a ligament.
- [Brad] Right, right.
Well, it maintains those two bones together.
- [Bob] Okay, the ball fits right in the socket here,
and there is a tendon that comes through the bone here.
Maybe we could show that.
Like all the way through even.
It won't even go through. - Nah, too big of a pen.
- [Bob] I'll just use my finger again.
- [Brad] Need a smaller pen.
- [Bob] The tendon goes right through here,
and if this bone travels up too far,
it can pinch onto that tendon,
and keep pinching to the point
where it actually wears it out.
- [Brad] Sure.
And that pinching almost always happens
when the person is reaching-
- [Bob] Up like that, yeah.
- [Brad] Over shoulder level.
- [Bob] Or turning it in.
That's why that bump here hits there.
So all these tests are trying to determine whether,
or not that pinching occurs.
And if it does, there's a good sign
that you have some impingement going on.
And then we have some videos that show you how
to try to decrease that.
- Right, some exercises to maintain it,
that joint.
So that impingement becomes minimized,
or abolished. - Right, so.
(metal rattling)
You agree with us, Napoleon?
- Say something, make him talk.
(Bob laughs)
Come on, big boy. (chuckles)
(bones clacking)
- Yeah, yeah, we can hit him on the head with his own arm.
(Brad chuckles)
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