There are more than seventy shoulder “special” tests. The validity of a test is usually compared against an established gold standard method. However, the relationship between shoulder imaging findings (frequently used as this gold standard) and symptoms is poor. For example, a study of people with unilateral shoulder pain showed that both the affected and nonaffrected side had a similar number of imaging findings.
Moreover, it should also be acknowledged that, for example, eight and nine muscles other than the supraspinatus are active during the full and empty can tests, respectively. The close interrelationship of multiple structures (tendons, capsule, bursae) and the accumulated inflammatory products mean that these tests are only irritating sensitive tissues.
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.
