To test specifically for an anterior impingement syndrome The Neer test is performed by internally rotating and passively flexing

the patients shoulder while keeping the arm inthe scapular plane . This maneuver reduces the space between the acromion and greater tuberosity and may elicit pain in rotator cuff tendonitis. Pain is typically elicited at greater than 90 of flexion.

In the Yocum test, the patients shoulder is abducted to 90, and the elbow is flexed to about 60. Using the hand and elbow as a fulcrum, the arm is forcibly put into internal rotation (Photo 12). This maneuver jams the supraspinatus tendon into the anterior surface of the coracoacromial ligament and acromion process. Pain is elicited in supraspinatus tendonitis.

When bicipital tendonitis is suspected, Speeds test is performed. In this test, the patient is instructed to supinate the arm, and the examiner resists the patients shoulder flexion. The test is repeated with thepatients elbow flexed to 90 (Photo 13). The test is positive when pain is elicited in the bicipital groove

To test more specifically for a SLAP lesion, and to differentiate it from an AC joint injury, the OBrien test is performed. In this test, the patient stands with the shoulder flexed to 90 and the elbow in full extension. The patients shoulder is then put into 1015 of adduction. With the patients hand supinated, the examiner puts an inferiorly directed force on the patients hand. The patient is then instructed tofully pronate the hand (such that the thumbs are pointing own) andthe examiner again places an inferiorly directed force onto the patients forearm (Photo 15). When the maneuver elicits pain insidethe shoulder when the hand is in supination, but not when the hand is in pronation, a SLAP lesion is suspected. However, this maneuveralso stresses the AC joint. Therefore, if this maneuver elicits pain in the AC joint, pathology should be suspected in the AC joint and not in the labrum.