Rotator Cuff and Shoulder Girdle Tests

The following tests reveal muscle problems that may underlie shoulder pain and dysfunction. Always get appropriate medical attention and tests. (For rotator cuff tears, a sonograms for major tears, but not small ones; an MRI best detail.) But always check muscles.

A "frozen shoulder" resulting from adhesive capsulitis can be less painful and more rigid than a shoulder restricted by myofascial TrPs [trigger points]. TrPs in rotator cuff muscles, especially subscapularis, can mimic adhesive capsulitis symptoms. On the other hand, it is not unusual for both conditions to coexist; both need appropriate treatment.

For extensive information on differential diagnosis of shoulder and rotator cuff problems see Travell, J. G. and Simons, D. G. (1999),Myofascial Pain and Dysfunction-- The Trigger Point Manual, Vol. 1. Available from www.Amazon.com and www.lww.com

Mouth Wraparound Test Infraspinatus Middle Deltoid Subscapularis Posterior Deltoid Supraspinatus Teres Major Latissimus Dorsi Levator Scapula Splenius Cervicis Teres Minor Coracobrachialis	This is the single most important test for shoulder girdle dysfunction. Combine with Backrub Test, below.   Position patient’s head at 45o to shoulders. Patient reaches arm around back of head to mouth. Substitution: Increasing head angle to reach hand. Maintain proper posture. A. No restriction: Short upper arms should reach corner of mouth; Normal arms: center of mouth; Hypermobile arms: opposite side of mouth.    B. Restriction: Primarily middle deltoid/infraspinatus with other possible involvement.If patient is: Unable to reach back of neck: subscapularis. Able to reach to ear only: infraspinatus. Able to reach over head but not behind it: posterior deltoid, coracobrachialis. Unable to hold arm in abduction: supraspinatus. Unable to rotate head to 45o for this test. See Cervical Rotation Test.
Backrub Test Coracobrachialis Anterior Deltoid	Patient reaches across lower back to opposite side. Note distance achieved and difference between one side and the other. Press at elbow, pushing arm downward and slightly to the rear (away from the body). A. No restriction: Knuckles of palm extend beyond spine. B. Restriction: Knuckles reach only to midline. Restriction rare in persons of normal weight. Failure, or pain or weakness on resistance: severe restriction in coracobrachialis, or a severely injured anterior deltoid; see Arm Abduction Test. Unable to reach behind back: supinator; see Supinator Test.
Hand to Shoulder Blade Test Infraspinatus Anterior Deltoid Supraspinatus Subscapularis Supinator Pectoralis Major Latissimus Dorsi Teres Minor	Patient reaches open hand behind back, wrist straight. Observe hand level relative to spine of scapula. Measure any side-to-side variation. Substitution: Bending wrist to reach higher up back. A. No restriction: Fingertips reach spine of scapula. B. Restriction: Fingertips cannot reach spine of scapula. If patient: Can barely reach hip pocket: infraspinatus (primary) and anterior deltoid (secondary). See Arm Abduction Test. Supraspinatus usually involved with infraspinatus (see Mouth Wraparound Test) or upper trapezius (see Cervical Lateral Flexion Test). Is slightly restricted after treating infraspinatus: teres minor. Can overcome shortening and weakness through passive motion (such as walking fingers or wrist up back: subscapularis. Has restriction with pain in supinator reference area of thumb; difficulty bending elbow to reach behind back. See Supination Test. Still has restriction after working the above: pectoralis major (see Shoulder Drop Test), latissimus dorsi (see Overhead Reach Test).
Overhead Reach Test Triceps Teres Major Latissimus Dorsi	Patient brings arms together over top of head as if clapping hands. Determine whether patient can bring arms in to touch ears, palms together, fingers level. Substitution: Tilting arms away from short side to equalize reach. A. No restriction: Can touch ears with insides of arms, arms reach same height, fingertips aligned. B. Restriction: With severely shortened triceps or teres major, one arm or (or both) will be bent, and it may be difficult or painful to press arms to ears. If not possible to move arm behind ears, teres major (see Mouthwrap Test), coracobrachialis (see Backrub Test), and latissimus dorsi may also be involved.
Over Shoulder Reach Triceps	Raise arm to shoulder level, arm out, palm up. Flex elbow to place palm on same-side shoulder, palm down. Slide palm down back, pointing elbow to ceiling. Substitution: Dropping head forward to bring ear forward of arm. Shifting arm out to side to relieve tightness in triceps. Keep arm and elbow perpendicular to body. A. No restriction: Elbow vertical or beyond ear. B. Restriction: Cannot point elbow to ceiling. Note: The photo from which this sketch was made was not a staged shot. It shows actual Before & After treatment range of motion. Compare active pre-treatment triceps trigger points (B) with improved range of motion immediately after treatment (A).