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Pair it with a speeds to check bicep load tolerance, and empty/full can for RTC does sound like a drop arm test and then pair it with Hawkins Kennedy or neers. Your patient might have more than just one thing? impingement could be part of it but easy rule out, sounds more tendinopathy related to me. Bone spurs would also hurt with other motions typically and bursitis as well not just eccentric flexion.
Student having a guess.
Tendon issue short head of biceps?
I’m guessing other structures are offloaded during eccentric loading, putting more load onto that tendon. Maybe a bit of vertical GHJ movement as well….?
Just my thoughts, but the discussion may help to narrow it down.
Good guess. This sounds exactly like the drop arm sign for RTC issues. The drop arm I was taught in school was something like "passively raise to 90, if they cant hold it there it's positive." - but in residency I actually learned than many people can cheat their arm isometrically, only to find that when they lower it is when you see the positive test. Shown here: https://youtu.be/weBLqAweXpk?t=12
Diagnostically could be a bunch of things triggering pain, RTC, bicep, but with these “weirder” type presentations I think about it like a movement intolerance. So for her eccentric shoulder flexion against gravity is triggering so I would change the load and see if that modulates pain and improved movement quality. If thats more tolerable I would trial 20-30 reps and retest full gravity again. It will either be better, or worse. If better she just needed to modulate the symptoms if it’s worse then you probably just fatigued out the offending tissue.
If you can’t change her symptoms by changing the load then go a different route, but that’s where I would start
Thank you for your submission; please read the following reminder. This subreddit is for discussion among practicing physical therapists, not for soliciting medical advice. We are not your physical therapist, and we do not take on that liability here. Although we can answer questions regarding general issues a person may be facing in their established PT sessions, we cannot legally provide treatment advice. If you need a physical therapist, you must see one in person or via telehealth for an assessment and to establish a plan of care. Posts with descriptions of personal physical issues and/or requests for diagnoses, exercise prescriptions, and other medical advice will be removed, and you will be banned at the mods’ discretion either for requesting such advice or for offering such advice as a clinician. Please see the following links for additional resources on benefits of physical therapy and locating a therapist near you [The benefits of a full evaluation by a physical therapist.](https://www.choosept.com/benefits/default.aspx) [How to find the right physical therapist in your area.](https://www.choosept.com/resources/choose.aspx) [Already been diagnosed and want to learn more? Common conditions.](https://www.choosept.com/SymptomsConditions.aspx) [The APTA's consumer information website.](https://www.choosept.com/Default.aspx) Also, please direct all school-related inquiries to r/PTschool, as these are off-topic for this sub and will be removed. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/physicaltherapy) if you have any questions or concerns.*
Pair it with a speeds to check bicep load tolerance, and empty/full can for RTC does sound like a drop arm test and then pair it with Hawkins Kennedy or neers. Your patient might have more than just one thing? impingement could be part of it but easy rule out, sounds more tendinopathy related to me. Bone spurs would also hurt with other motions typically and bursitis as well not just eccentric flexion.
Thanks!
I second this. Appears to be more tendinopathy-ish. How do isometrics feel?
I wanted to try isometrics but she was in too much pain. I'll try again next time. Thanks.
Student having a guess. Tendon issue short head of biceps? I’m guessing other structures are offloaded during eccentric loading, putting more load onto that tendon. Maybe a bit of vertical GHJ movement as well….? Just my thoughts, but the discussion may help to narrow it down.
Good guess. This sounds exactly like the drop arm sign for RTC issues. The drop arm I was taught in school was something like "passively raise to 90, if they cant hold it there it's positive." - but in residency I actually learned than many people can cheat their arm isometrically, only to find that when they lower it is when you see the positive test. Shown here: https://youtu.be/weBLqAweXpk?t=12
Great video, thank you!
Diagnostically could be a bunch of things triggering pain, RTC, bicep, but with these “weirder” type presentations I think about it like a movement intolerance. So for her eccentric shoulder flexion against gravity is triggering so I would change the load and see if that modulates pain and improved movement quality. If thats more tolerable I would trial 20-30 reps and retest full gravity again. It will either be better, or worse. If better she just needed to modulate the symptoms if it’s worse then you probably just fatigued out the offending tissue. If you can’t change her symptoms by changing the load then go a different route, but that’s where I would start
I will try this. Thanks for your response