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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.