Shoulder Examination / Subacromial, Cuff - Everything You Need To Know - Dr. Nabil Ebraheim

Dr. Ebraheim’s educational animated video describes the clinical evaluation tests for Shoulder and Rotator Cuff injuries.
Neer’s test
•Position of the patient: patient is standing or sitting upright.
•Performing the tets: the examiner will passively elevate the pronated arm of the patient above the level of the shoulder.
•Positive finding: pain at the anterolateral aspect of the shoulder indicates subacromial impingement.
Hawkin’s test
•position of the patient: patient is standing or sitting upright with the arm fully adducted and forwardly flexed. The elbow is also flexed.
•performing the test: the examiner will place one hand on the patient’s shoulder and apply internal rotation to the affected arm with the other hand.
•positive findings: pain at the shoulder indicates subacromial impingement.
Drop arm test:
•position of the patient: patient is standing or sitting upright.
•performing the test: the patient is asked to hold the affected arm in abduction at the level of the shoulder then smoothly adduct the arm.
•positive findings: a patient who is suffering from a rotator cuff tear can lower the arm smoothly to the side. A patient suffering from a rotator cuff tear will not be able to hold the arm in abduction and the arm will drop rapidly.
Belly press test
•position of the patient: patient is standing with the hand of the affected arm at rest against the stomach with the elbow anterior to the midaxillary line.
•performing the test: the patient is then asked to press the belly using the affected arm without moving the elbow.
•positive findings: failure to maintain the elbow anterior to the midaxillary line while pressing against the belly indicates predominantly an infrapsinatus tendon tear.
Lift off test
•position of the patient: patient is standing with affected arm internally rotated behind the back so that the dorsum of the hand will be resting on the lumbar area.
•performing the test: the examiner will passively lift the arm away from the patient’s back.
•positive findings: once the examiner releases the arm, failure to maintain the position of the arm away from the back indicates a subscapularis tendon tear.
Adduction/external rotation test
•position of the patient: patient is standing with the affected arm adducted (slightly abducted) and elbow flexed.
•performing the test: the examiner will fully externally rotate the arm.
•positive findings: with the release of the arm, failure to maintain active full external rotation indicates a supraspinatus and infraspinatus tendon tear.
Jobe test
•position of the patient: patient is standing or sitting upright. The arm should be anteriorly flexed at the level of the shoulder. Fully pronate the arm into “empty can position”
•performing the test: the patient should resist the downward force applied on the forearm by the examiner.
•positive findings: pain or weakness indicates a supraspinatus tendon lesion.

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[samwinter]

Impingement test
1. Neer test- Arm passively flexed from elbow
2. Hawkins test- Shoulder flexed and adducted. Elbow flexed across chest.
IR applied. Pain

Rotator cuff tests:
1. Drop arm test- Supraspinatus, cannot lower arm from abduction
2. Belly press test- Subscapularis unable to press on stomach without bringing elbow anteriorly, in front of midaxillary line
3. Lift off test- Subscapularis
Unable to keep arm away from small of back when IR
4. Adduction/ER- Supra/infra spinatus
Arm placed into adduction and ER
Failure to maintain full ER
5. Jobe test- supraspinatus
Anteriorly flexed and fully pronate
Resist downwards force, pain or weakness

Innervation:
Supraspinatus & Infraspinatus- Supraspinatus nerve
Subscapularis- upper and lower Subscapularis nerve
Teres minor- Axillary nerve

Action
1. Supraspinatus- Abducts
2. Infraspinatus- Greater tubercle, ER humerus.
Test for ER weakness
3. Teres minor- Greater tubercle, ER
4. Subscapularis- Lesser tubercle, IR
See Hyperabduction and ER
Lift off and belly press

[allenz]

Nice video, Doc. But just one error: Belly-press test is to detect SUBSCAPULARIS muscle whose function is to internally rotate the humerus, not infraspinatus(lateral rotate).

[nabilebraheim]

you are correct, the test is for subscapularis tear

[xerxescolah]

Doctor I salute your clarity and contributions.

[FASHIONFILMSINC]

one of the best videos I've ever watched

[nanz]

this is what practitioners need to help the patients thankd for this video more power

[nabilebraheim]

I WAS UNABLE TO GET ALL THE TESTS IN ONE PAGE
WILL HAVE SUBSCAP EXAM VIDEO

[vghafarian]

You spent your time to better educate people who you don't know them but they will apply your knowledge to their patients. I deeply appreciate your kind intention and efforts. Vahid

[airwayny]

The deltoid only starts to be the primary abducter when the arm is 25 degrees or so from neutral. The supraspinatus does the first part. Also when the rotator cuff tendons are inflamed, the impingement keeps smooth abduction and adduction even at 90 degrees or so. Excellent video Dr. Nabil!

[TheSandkastenverbot]

Wow, this is pure gold! Thank you so much!

[ful]

It is really very helpful for those who have shoulder pain. Nice video sir.

[sureshbabu]

Thanks for your dedicated experiment for medical science and the sake of people

[drmubashir]

Belly press test is for subscapularis muscle. Sir you have probably by mistake showed that it is for infraspinatus muscle.

You must have categorize shoulder test as follows

1) impingement test( neer, hawking, scarf or cross arm test.)
2) instability tests. ( sulcus test, anterior n posterior translation or load shift test, apprehension test, jobes relocation test)
3) rotator cuff insufficiency tests( empty can test for supra spinatus, gerber lift-off and belly press tests for subscapularis, adduction external rotation for infraspinatus, abduction external rotation or horn blower test for teres minor.)
mentioned the instabilty tests as well.

[akvlogs]

VERY MUCH SIMPLE AND USEFUL...THANK YOU

[neojeets]

Thanks for the video. Its a good reference when trying to understand my shoulder pain.

[sumantsinha]

Nice video and informative too sir ; but in the test heading " Belly Press Test " ; you write it for subscapularis muscle, but in demonstration of test you have written Infraspinatus tendon lesion. Any explanation Pl .

[HCarota]

2:08 belly press test -> infraspinatus? Please correct with subscapularis

[bimetsherojne]

thank you very much for this great video

[nabilebraheim]

Thank you both for watching. Please share the videos you enjoy.

[AnthonySell]

With all of these tests, I think that jumping to the conclusion of a tear or a lesion in the muscle or tendon is a bit premature. You would first have to rule out an imbalance of tension in the antagonist muscles, or a condition where the indicated muscles may be fatigued or atrophied due to overuse or misuse, habitual postural defects, etc. Combine these with specific muscle tests and you will get a much more accurate picture of what is going on.