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

the patient’s 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 patient’s 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, Speed’s test is performed. In this test, the patient is instructed to supinate the arm, and the examiner resists the patient’s shoulder flexion. The test is repeated with thepatient’s 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 O’Brien test is performed. In this test, the patient stands with the shoulder flexed to 90° and the elbow in full extension. The patient’s shoulder is then put into 10–15° of adduction. With the patient’s hand supinated, the examiner puts an inferiorly directed force on the patient’s 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 patient’s 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.

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