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Special tests for the supraspinatus muscle

This is an excerpt from Pocket Atlas of Special Tests for the Upper Limb, The by Jane C. Johnson.

The supraspinatus muscle lies in the supraspinous fossa on the posterior of the scapula and attaches also to the head of the humerus (figure 3.1). Supraspinatus is primarily an abductor of the humerus and is capable of fully abducting the humerus into elevation. This muscle also helps to stabilize the head of the humerus within the glenoid fossa.

Figure 3.1: The supraspinatus muscle.
Figure 3.1: The supraspinatus muscle.

The special tests included for supraspinatus are the supraspinatus-specific Painful Arc Test, the Hawkin’s-Kennedy Test, the Champagne Toast Test, Jobe’s Test (which you may know as the Empty Can Test)—to be contrasted with the Full Can Test, Yocum’s Test, the Drop Arm (Codman’s) Test, and Neer’s Impingement Sign.

Painful Arc Test

Figure 3.2: Painful Arc Test, showing the 120°–160° arc of pain indicating supraspinatus pathology.
Figure 3.2: Painful Arc Test, showing the 120°–160° arc of pain indicating supraspinatus pathology.

Purpose: This tests for pathology affecting the supraspinatus tendon.

Type of Test: This is an active pain-provocation test. As the test also requires contraction of the shoulder abductor muscles, it tests the strength against gravity of the supraspinatus muscle and the medial fibers of the deltoid muscle.

Procedure: Ensure your client begins with a good, upright sitting or standing posture, as protraction of the scapula affects the test result. Instruct them to abduct the arm through the full ROM.

Findings: Between 160° and 120° of abduction, the supraspinatus tendon is impinged between the acromion and the greater tubercle of the humerus (figure 3.2). Therefore, pain within this range suggests a supraspinatus pathology.

Tip: This test is also used to assess the AC joint, which typically elicits pain in the 140° to 180° range of abduction. Other shoulder pathologies can give rise to a painful arc.

Hawkins-Kennedy Test

Figure 3.3: Hawkins-Kennedy Test, showing passive internal rotation of the arm with the shoulder and elbow at 90°.
Figure 3.3: Hawkins-Kennedy Test, showing passive internal rotation of the arm with the shoulder and elbow at 90°.

Purpose: Described by Hawkins and Kennedy (1980), this tests for subacromial impingement pain.

Type of Test: This is a passive pain-provocation test.

Procedure: With your client seated, passively flex the shoulder and elbow to 90° (figure 3.3). Stabilize the scapula with one hand, and with your other, internally rotate the arm by holding it at the elbow.

Findings: The test is positive if it reproduces the patient’s shoulder pain.

Champagne Toast Test

Figure 3.4: Champagne Toast Test, with arrows indicating the direction of force applied by the clinician (a) and the direction of force applied by the client (b).
Figure 3.4: Champagne Toast Test, with arrows indicating the direction of force applied by the clinician (a) and the direction of force applied by the client (b).

Purpose: Proposed by Gregory P. Nicholson and described by Chalmers et al. (2016), this tests for pathology of the supraspinatus tendon.

Type of Test: This is a test requiring isometric contraction of the shoulder muscles.

Procedure: Ask your client to raise their arm as if holding a glass to make a toast. In this position the shoulder is in 30° of abduction, 30° of forward flexion, and slight external rotation, plus 90° of elbow flexion. Apply downward pressure to the arm (figure 3.4a) and ask your client to resist this (figure 3.4b), thus performing an isometric contraction.

Findings: The test is positive if it reproduces the client’s pain.

More Excerpts From Pocket Atlas of Special Tests for the Upper Limb, The

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