From the Guidelines
Supraspinatus tendinitis can be diagnosed using the Hawkins' test or the Neer's test. These tests are used to assess for impingement of the supraspinatus tendon, which is a common cause of tendinitis 1.
Diagnostic Tests
- The Hawkins' test involves forcible internal rotation with the patient's arm passively flexed forward at 90 degrees, and is sensitive (92 percent) for impingement 1.
- The Neer's test involves full forward flexion between 70 and 120 degrees, and is also sensitive (88 percent) for impingement 1. It is essential to note that while these tests are sensitive, they are not specific, and further diagnostic imaging may be necessary to confirm the diagnosis 1.
Clinical Considerations
In clinical practice, a combination of physical examination and diagnostic imaging is often used to diagnose supraspinatus tendinitis 1. The choice of test may depend on the patient's presentation and the clinical suspicion of impingement. It is crucial to consider the patient's medical history, occupation, and activities that may have contributed to the development of tendinitis.
From the Research
Tests for Supraspinatus Tendinitis
The tests for supraspinatus tendinitis include:
- Empty can (EC) test: considered the gold standard for testing, but does not fully eliminate the deltoid synergistic when resistance is applied 2, 3
- Full can (FC) test: also utilized, but does not fully eliminate the deltoid synergistic when resistance is applied 2, 3
- Diagonal horizontal adduction (DHA) test: a new technique developed for evaluation of the supraspinatus, which has been compared with the existing techniques (EC/FC) 2
- Drop arm test: showed the highest specificity for diagnosing supraspinatus tendon lesions 4
- Patte test: showed the highest ability to distinguish between full- and partial-thickness tears, and the best combination for detecting supraspinatus tears was the Neer sign and the drop-arm test 4
- Resisted external rotation: showed the highest ability to distinguish between full- and partial-thickness tears 4
Effectiveness of Tests
The effectiveness of these tests in diagnosing supraspinatus tendinitis is:
- The empty-can test showed the highest sensitivity (0.81) for overall supraspinatus tears 4
- The Patte test and the drop-arm test showed the highest specificity (0.99 and 0.98, respectively) for overall supraspinatus tears 4
- The best combination for detecting supraspinatus tears was the Neer sign and the drop-arm test (DOR, 12.92) 4
- The EC and FC tests do not primarily activate supraspinatus with minimal activation from other shoulder muscles, and therefore, do not satisfy basic criteria to be valid diagnostic tools for supraspinatus pathology 3
- A shoulder position of 30° abduction, 30° horizontal flexion, and external humeral rotation offers the best position to isolate the abducting activity of the supraspinatus from that of the deltoid 5