From the Guidelines
A positive scarf test during a shoulder examination indicates impingement of the supraspinatus tendon or other rotator cuff structures. This test is performed by horizontally adducting the patient's arm across their chest while the examiner observes for pain or limited range of motion. When positive, the patient typically experiences pain in the anterior or lateral shoulder region. This finding suggests potential pathologies such as subacromial impingement syndrome, rotator cuff tendinopathy, or subacromial bursitis. The pain occurs because the movement compresses the rotator cuff tendons between the humeral head and the acromion process of the scapula. A positive scarf test should prompt further evaluation, including additional physical examination maneuvers and possibly imaging studies such as ultrasound or MRI to confirm the diagnosis, as MR arthrography has been found to be reliable in diagnosing anterior shoulder instability and labroligamentous injuries 1. Treatment typically begins with conservative measures including rest, NSAIDs, physical therapy focusing on rotator cuff strengthening, and proper biomechanics, before considering more invasive interventions if symptoms persist. Key points to consider in the evaluation and management of a positive scarf test include:
- The clinical context and patient history to guide the choice of further diagnostic tests
- The role of imaging, particularly MR arthrography, in assessing shoulder instability and labral injuries 1
- The importance of a comprehensive treatment plan that addresses pain, function, and prevention of further injury.
From the Research
Shoulder Examination Techniques
The scarf test is a physical examination technique used to assess shoulder instability and labral tears.
- A positive scarf test is indicative of a superior labral tear from anterior to posterior (SLAP) lesion 2.
- The test is used in conjunction with other clinical tests, such as the apprehension test and the O'Brien's sign, to diagnose shoulder instability and labral tears 2.
- Labral tears, including SLAP lesions, can be caused by traumatic or degenerative processes, and may be associated with other shoulder conditions, such as rotator cuff tears and impingement 3, 4.
Diagnosis and Treatment of Shoulder Conditions
- The diagnosis of shoulder conditions, including labral tears, relies on a combination of clinical presentation, physical examination, and imaging studies, such as X-rays, MRI, and ultrasonography 3, 4, 5.
- Treatment options for shoulder conditions, including labral tears, may include non-operative management, such as physical therapy and corticosteroid injections, as well as surgical options, such as arthroscopic debridement and repair 3, 4, 5, 6.
- The choice of treatment depends on the specific condition, the severity of symptoms, and the patient's overall health and activity level 3, 4, 5, 6.