The Pain Source

Patient Position

• Seated or standing
• Shoulder elevated to 90° in the scapular plane
• Forearms fully pronated (thumb UP)

Procedure Steps

• Examiner instructs the patient to resist downward pressure on the elbow.

Positive Sign / Significance

• Pain, weakness in shoulder = Supraspinatus tendinitis/tear

Comments

• The supraspinatus is best isolated with the thumb UP (full can test), rather than with the thumb DOWN (empty can test)
• The empty can test is more likely to cause pain, and therefore may not show true weakness of the supraspinatus (due to a tear).
  • The full can test is now thought to be better because of this.

Related Content:

• Empty Can Test
• Diagnosis of Hip Pathology: The diagnostic validity of hip provocation maneuvers to detect intra-articular hip pathology
• VIDEO: Subacromial Bursa Injection under fluoroscopy
• VIDEO: Cervical Facet Injection
• Speed’s Test

aka. “Supraspinatus Press Test”

Patient Position

• Seated or standing
• Shoulder elevated to 90° in the scapular plane
• Forearms fully pronated (thumb down)

Procedure Steps

• Examiner instructs the patient to resist downward pressure on the elbow.

Positive Sign / Significance

• Pain, weakness in shoulder = Supraspinatus tendinitis/tear

Comments

• The supraspinatus is best isolated with the thumb UP (full can test).
• The empty can test is more likely to cause pain, and therefore may not show true weakness of the supraspinatus (due to a tear).
  • The full can test is now thought to be better because of this.

Related Content:

• Full Can Test
• Diagnosis of Hip Pathology: The diagnostic validity of hip provocation maneuvers to detect intra-articular hip pathology
• VIDEO: Subacromial Bursa Injection under fluoroscopy
• VIDEO: Cervical Facet Injection
• Speed’s Test

Patient Position

• Seated

Procedure Steps

• Patient’s arm is forward flexed to ~60°, elbow fully extended, and forearm supinated.
• Examiner resists further forward flexion by the patient, by applying downward pressure on the forearm.

Positive Sign / Significance

• Pain over the bicep tendon in the bicipital groove = Bicipital tendinitis or tear (long head of biceps)

Comments

• May also cause vague shoulder pain with a superior labral anterior-posterior tear (SLAP lesion)

Related Content:

• Full Can Test
• Empty Can Test
• Tinel’s Sign at the Wrist
• Phalen’s Test
• Cozen’s Test

Patient Position

• Seated or standing

Procedure Steps

• Forward flexes the affected shoulder to 90°.
• Adduct the shoulder horizontally across the chest

Positive Sign / Significance

• Localized pain over the acromioclavicular joint = Acromioclavicular joint painful osteoarthritis

Related Content:

• Acromioclavicular Joint Injection – Technique and Tips
• Ultrasound-Guided versus Palpation-Guided Acromioclavicular Joint Injections
• VIDEO: Subacromial Bursa Injection under fluoroscopy
• VIDEO: Cervical Facet Injection
• Full Can Test

aka. “Hawkins-Kennedy test”

Hawkins Impingement Test

Patient Position

• Seated

Procedure Steps

• Examiner stands in front of, or to the side of the patient.
• Involved shoulder is forward flexed to 90°, and the elbow is flexed to 90°
• Examiner supports the forward flexed arm with one hand, while internally rotating the shoulder (humerus).

Positive sign / Significance

• Shoulder pain = Supraspinatus tendinitis/impingement

Related Content:

• VIDEO: Subacromial Bursa Injection under fluoroscopy
• Neer’s Impingement Test
• Pes Anserine Bursa Injection – Technique and Tips
• Acromioclavicular Joint Injection – Technique and Tips
• Subacromial Bursa Injection – Technique and Tips

Patient Position

• Seated

Procedure Steps

• Involved shoulder is slightly abducted.
• Forward flexion (passively) of the arm in the scapular plane, until the upper arm is close to the ear.

Positive sign / Significance

• Shoulder pain = Supraspinatus tendinitis/impingement

Comments

• Procedure causes an impingement of the supraspinatus tendon between the humeral head and the anteroinferior acromion process.
• May also be positive with bicipital tendonitis (long head).

Related Content:

• Hawkins Impingement Test
• VIDEO: Subacromial Bursa Injection under fluoroscopy
• Empty Can Test
• Ultrasound – Shoulder Exam Setup
• VIDEO: Glenohumeral Shoulder Intraarticular Steroid Injection Under Fluoroscopy