MEDizzy - A 49-year-old man presents to your office complaining of

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Acute Complaints

A 49-year-old man presents to your office complaining of right shoulder pain for the past 6 months. He denies prior injury and works as a mason. His pain is worse at night when he is trying to sleep and with overhead motions at work. He denies neck pain, numbness/tingling, or loss of strength. You suspect rotator cuff tendonitis. Which of the following examinations is most likely to be positive (or abnormal) in this patient?

ExplanationRotator cuff tendonitis is most common in men between the ages of 40 and 50. Hawkins test, which is positive when the patient has pain and/or diminished motion when the shoulder is passively moved into internal rotation and forward flexed to 90 degrees, has almost 90% sensitivity but only ~40% specificity for diagnosing rotator cuff tendonitis. The cross-arm maneuver is specific for acromioclavicular (AC) joint pathology and is performed by passively moving the extended arm across the body toward the other shoulder. Spurling maneuver, axial compression of the cervical spine, is used to diagnose cervical spine pathology and/or radicular symptoms cause by cervical spine dysfunction. The sulcus test, a noticeable gap between the acromion and humeral head with a caudal load, is a sign of glenohumeral joint instability. The O’Brien test is useful to diagnose labral pathology and AC joint pathology. The evaluator asks the patient to forward flex their extended arm to 90 degrees and then internally rotates the arm and slightly adducts. A positive test occurs if downward pressure applied to the arm results in pain. This test has been shown to have close to 100% positive and negative predictive value.