Time to end “special” tests for rotator cuff-related pain

What’s so special about “special tests” for rotator-cuff related shoulder pain?

This viewpoint article has three main conclusions:

  • Shoulder “special tests” are not able to discriminate which structure causes rotator cuff-related shoulder pain; 
  • This lack of diagnostic ability means that recommending surgical/ conservative interventions for a specific structure based on the results of “special tests” is not acceptable;
  • Ruling RCRSP in or out can be done through a comprehensive interview (which includes questions about loading patterns, patient beliefs, and lifestyle factors) and physical examination (which includes excluding referred pain, active and passive range of motion, strength, and load responses).

Shoulder “special tests” should therefore be left out of adequate management of a patient with suspected rotator cuff-related shoulder pain should therefore include a comprehensive interview, red flag screening, disability questionnaires, physical examination, providing patient education and advice, and if conservative treatment is chosen, care provided based on the evaluation of physical activity and function rather than imaging.

> From: Salamh et al., J Orthop Sport Phys Ther 50 (2020) 222-225 (Epub ahead of print). All rights reserved to Journal of Orthopaedic & Sports Physical Therapy. Click here for the online summary.

Expert opinion

This viewpoint sends a clear message – shoulder “special tests” do not offer any benefit and may misguide the clinical decision-making process for patients with rotator cuff-related shoulder pain, delaying adequate care.

This also brings the question: why are there so many and why are they so widely used? As mentioned by the authors, multiple factors may be at play. First, the notion that a specific culprit for the symptoms can be quickly identified in the clinical setting is comforting. Second, there’s the “we’ve always done it this way” factor. Many practitioners are resistant to change when they have had the same practice patterns for so long. On the other hand, these tests are still routinely taught at the undergraduate level, which means younger physiotherapists may lack other tools for managing these cases.

This means that despite their lack of usefulness, this change may take time to break through these walls and reach widespread clinical practice. It is up to each one of us to make sure this change is as quick as possible.

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