♪ 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 therapist
on the internet.
- In our opinion, of course Bob.
- Three best self tests for supraspinatus tear or injury.
This is a common shoulder pain,
probably one of the most common ones there is.
- Right. I would agree Bob, but not only that,
of the supraspinatus problems, most of those are
probably impingement problems, which we hear about a lot.
- Sure. Before we go into the weeds here
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- Yeah. We got that going for us.
All right, so again, yeah, not only is this the most
common shoulder pain,
it's probably the most commonly injured tendon.
Wouldn't you say?
- Oh, right, right.
- Of the possible tendons up in the shoulder.
- Right. I would say 80, 90% of the people I rehab
after rotator cuff surgery,
it's this tendon.
- Sure.
- So, which tendon are we talking about?
Let's be a little more specific if you're not familiar
with the anatomy.
First of all, we're looking at the right shoulder here
and we've got a nice little model here of the shoulder
and this is actually the scapula,
- or the shoulder blade.
- Or the shoulder blade.
Right back here.
- Back here, yeah.
- So there, there we are.
This is this Bob's.
I'm gonna pop it right off of him there.
You don't have it there.
And now we are to take the muscles
off the big Deltoid muscles, we'll remove those.
And of course the skin.
And now we're looking at just the muscles
of rotator cuff.
- Yeah. Yep.
- We've got two here.
We've got the supraspinatus here.
Can I get, should I get a little closer, Liz?
- There we go.
- And then of course we've got the one on the inside.
You got all those memorized, Bob.
- Yeah sure. SITS.
(chuckles)
- What?
- SITS. SITS
- Yeah. S I T S
- Subscapularis, infraspinatus, supraspinatus,
and teres minor.
- There you go. Yeah.
- Unbelievable.
- Yeah.
- You remember that from school?
- Yeah.
- I was just testing him.
- So anyways, we're looking at the supraspinatus
'cause here's the spine of the scapula,
supra means above,
so we got the supraspinatus.
- Yeah.
- And the tendon, if you look here
you can see the tendon is actually a broad tendon.
It's not like that tendon you commonly see in your bicep.
And actually, I always thought this was kind like that,
but after investigation, it's very clear.
It's a broad tendon and it's part of the rotator cuff.
- I agree with you a hundred percent, Brad,
I thought it was a thin, narrow tendon too,
but it's a big, broad, and that's why you can kind
of get pin holes in it and you can get partial tears.
- Right.
- And there's still a lot of tendon holding things in place.
- There you go.
So the first thing we're gonna do to test is simply actually
what we call palpate or feel right over that tendon
and see if it's inflamed or tender.
So there's a nice little test that if you take your hand
and the palm, the backside of your hand and put it
right where your pocket opens up right there,
that's over your greater trochanter like this,
that internally rotates the humorous,
and then you're gonna go to the top.
You're gonna find that bone the acromion,
that's only bone that really has no muscle on it.
Then you're gonna go forward and drop down about an inch.
And you're gonna just push into there and rub back and forth
and see if there's a tender area.
Now, sometimes it's tender and it's healthy,
'cause you're pushing too hard or you're pinching it
or depends on how sensitive you are.
But if you compare it to the opposite shoulder,
that's so nice with all these tests, do it on one shoulder
and then do it on the other and see if you notice
a significant difference.
And that's one of the tests, is right there.
Okay. If it's like, whoa! This is tender, you'll know,
'cause it kind of makes your eyes open up
and you don't wanna do it.
- Not, not very subtle.
You know, you can tell right away.
- There you go.
So again, compare right to the left,
that's test number one.
Number two, we call it scaption flexion. Okay.
So in therapy words,
we say flexion is straight up in front
and the abduction is out the side.
Well, scaption is kind of not halfway in between
but it's a pretty close to that where this is
straight out to the side, straight in front.
We're gonna go right.
- Kind of in between.
- Right.
- About, you just figure about halfway
and then you're just gonna go up like this.
Now that is, the muscle that's responsible for that
largely is the supraspinatus.
Now we can get more particular and go palm down.
This is called the empty can test and do that.
And that really gets at that supraspinatus.
- Now, Brad, would you want them doing
both at the same time to compare?
Or would you just do one at a time?
- Well, I would just do one at a time.
But you could try both in, you know,
it's gonna be pretty clear on this one.
If one feels fine and the other one hurts
and particularly more, you know, out this range,
and then with the palm down, the empty can test even.
- And how does it work Brad?
I just recently went through this, supraspinatus tendonitis,
and mine is still a little bit sore.
- And you notice it.
- Yeah. And I notice on this side, this is the only test
of the ones we're doing today that I notice it on.
I don't notice it on, I don't palpate, I don't figure it...
- Okay, so it's still hanging in there.
- Still hanging in there, but it's much, much better.
I don't notice it throughout the day at all.
- Sure.
- Now this one, I see a lot with patients.
It's called, I call it the painful arc syndrome.
- Oh, sure.
- Yeah. But we're gonna go in abduction,
so straight out to the side,
your palm is gonna be down as you go through it.
It's not thumb up or palm up.
It's palm down.
And then you just go out to the side.
Now, if you feel some pain in this range
that's the painful arc syndrome.
But then once you get above 90 degrees
in this area, it's like, oh, feels okay up in here.
And then when you lower, it's like,
oh, it hurts again coming down through that range.
That's another positive sign that you may have
supraspinatus impingement or inflammation.
- So again--
- Yeah. I feel just a little bit now.
- Little bit there?
- Little bit. Yeah, compared to this side.
- And then when you get up higher it's okay.
- It's fine.
- Right. We're not gonna get into the mechanics of it,
but as a therapist, it really makes sense why that happens.
So go through all three of these tests,
compare one side to the other and then see
if one of them is positive
or like Bob has two that are semi positive.
- Semi positive.
- Yeah. So maybe he's got some supraspinatus injury,
or impingement, but it's that clear.
If it's like real tender,
this empty can one hurts
and this one you can't get through that 80 degree range,
you know, it's not a hundred percent certain
this is a problem but it's a pretty good chance then.
- So if you find that, just go, you know,
type in Bob and Brad and YouTube and put Impingement.
- Right.
- And we'll have lots of videos on how to treat this.
- Right. Or we have some under supraspinatus as well.
- Supraspinatus as well, yeah.
- We do got a few videos out, Bob.
- Yeah. We do 1300, I think, so.
- We're trying to help in every which way we can.
So once again, Bob,
we can cure just about anything except...
- A broken heart.
- There you go, Bob.
But once again, we'll continue to...
- Persevere.
Exactly right, Bob.
- All right.
- That's what they said about Edison.
He did a lot of persevering--
- On the light bulb.
- He got it.
- He failed a thousand times.
- I think it was 10,000
- 10,000 times.
- I think so.
- Okay.