The Shoulder’s ‘Special’ & Not So “Special’ Tests

Posted By: Andy Barker

When it comes to the shoulder and special testing, the biggest mistake that I see New Grad’s make is doing too many tests…

And worse than this…

Relying too much on special testing to make a diagnosis.

This is a big problem.


In short, because most of the special tests at the shoulder are $*&£.

They lack sensitivity and specificity and as such, are not great tests to use to make a correct diagnosis.

So, if you are relying too much on special tests during your assessments, it is going to make your job to find a clear diagnosis at the shoulder, much more difficult.

In this blog you will discover the best special tests to use during your shoulder assessments, and which ones to avoid…

So you no longer rely so much of your clinical diagnosis on special testing.

Let’s find out how to do this.

Why All New Grad’s Make The Same Assessment Mistakes

Like you, I also used to do too many tests at the shoulder and get my head in a whirl about what the actual problem was.

But if you think about it, it’s no surprise.

At University we were taught like this.

So much value was placed on special testing to make a diagnosis, not only at the shoulder, but for just about every injury.

This is ok for certain tests like the anterior draw test for a suspected ACL injury…

Or a slump test for a suspected disc related lower back pain patient.

These tests are accurate, and if performed correctly will help you find the right problem.

But this doesn’t work for the shoulder.

Firstly, so many different shoulder structures can cause the same patient symptoms, so differentiating between different injuries in this area can feel almost impossible.

Secondly, the special tests at the shoulder are not as helpful as those ACL or lower back tests, as they don’t add as much value to the clinical picture, because of their poor sensitivity and specificity.

So whilst relying on shoulder shoulder special testing to make a diagnosis was how you were taught at University…

Clearly this is not the best way!

The Shoulder Assessment Game-Changer

There is no magic test or bullet to a better shoulder assessment.

But more testing or better testing is the complete opposite is exactly what you do NOT need.

You just need to learn how to test ONLY what you need to test.

This may or may not even include special testing.

I’ll explain now what I mean…

When you learn to only test what you need to test, it becomes much easier to make a diagnosis…

And help better manage the patients and athletes you see with shoulder pain.

By limiting your testing you actually get better information.

You cut out the noise and prevent yourself becoming overwhelmed with too much information.

It is this extra noise and useless assessment testing results, that make you feel lost and confused about what is actually going on.

Cutting out this noise you will be able to make sense of your patient assessments…

And this will give you the confidence you need to make that patient diagnosis.

The best bit?

Because you can identify your patients actual problems, you can then design a logical treatment plan about how to tackle these problems and your patients shoulder problem.

This stops you guessing and just throwing the kitchen sink of treatments and rehab at your patient hoping something will work.

And even better than this…

Cutting out unnecessary testing means that not only you get the information you need to limit this confusion…

Your assessments will take less time, meaning more time to spend on treatment and rehab…

Stopping that mad dash at the end of each session to do this quickly before the time runs out and your next patient is due!

So are you saying to not use special tests?

I’ll explain more here…

The Not So ‘Special Tests’

You already know that there is a relatively poor evidence base for many special tests and especially those at the shoulder, even if clustered together.

Just take a look at this paper…

Table Adapted From: The Diagnostic Accuracy of Special Tests for Rotator Cuff Tear: The ROW Cohort Study. Jain et al (2017), American Journal Physical Medicine & Rehabilitation, 96 (3), pp. 176-183.
Jain et al (2017) looked at the current commonly used shoulder special tests and found sensitivity scores as low as 8% and specificity as poor as 48 % for those used for trying to identify rotator cuff tears.

In this paper, the authors concluded that only the Jobe’s test (empty can test) and the full can test showed high enough results to be predictive for a rotator cuff tear to the supraspinatus.

In short, other than those two tests for one specific rotator cuff tear, the rest are not helpful to make an accurate diagnosis.

These words from Magee (2014) summarise shoulder special testing well…

‘it is not possible to make a definitive diagnosis with the clinical tests currently in use”

If there is one main thing I want you to take away from reading this blog it is to understand that you can NOT rely just on your ‘special’ testing to find out what’s going on with your patient’s shoulder.

I am NOT for one minute saying you should NOT use special testing at the shoulder.

What I am saying, and this is backed up by the evidence, is that most shoulder tests are not where near as helpful as they are in other joints like the hip, knee or ankle.

This places a greater value of the rest of your objective assessment.

This is exactly the reason I structure my assessments in a certain way and why I teach other therapists within my New Grad Physio Membership to do the same.

This method is the same whether I am treating a shoulder, lower back or an ankle injury.

I have 6 simple assessment steps.

Special testing is the 6th and final step.

In many cases if you do a good job in the rest of your assessment (Steps 1-5), you don’t even need to do any special testing.

This works particularly great for the shoulder, because as we know, the special tests are not great.

I’d always ask you to consider before doing any special test…

If a test is NOT going to add anything to the clinical picture…

And is NOT going to change your management of your patient with shoulder pain, then WHY are you doing that test?

This is clinical reasoning.

Understanding what the evidence says and being able to apply it in the real world with real patients.

Applying the right tests during your assessment and not just testing everything, like you were taught at University.

Do too much and you just make things too complex.

A basic shoulder assessment done ‘brilliantly’ will give you all the information you need.

Once you start getting positive results and your patients symptoms stop returning as soon as they leave the clinic…

You will build more competent with your shoulder assessments and feel more confident to effectively assess and your patient’s with shoulder and any other injuries, even the more tricky ones.

To look and feel more confident with your patient’s is made easy if you follow as simple assessment structure and don’t try to overcomplicate your assessments.

Clinically reason what you are doing before you do it…

And you will see how even a simple assessment structure can help you get quick and long-lasting patient results…

…even with those tricky ones and even with those with injuries that you might not even have heard of before!

Want To Learn More?

If you want to really improve your confidence assessing and treating shoulder injuries, then you need to check out my latest FREE resource…

The 5 Breakthrough Steps To Confidently Treat The Shoulder Right Every Time, Avoid Mistakes And Stop You Feeling Less Adequate Than Other New Grads

In this resource I go into further detail about special testing at the shoulder, summarising the latest evidence on the best tests to use and how you should use these tests in your patient assessments.

In this special resource you will also discover…

1) The #1 Reason Why New Grads Can’t Seem To Get The Right Diagnosis No Matter How Hard They Try!

2) Why You Should Never Trust People Who Tell You That The Shoulder Is ‘Complex’ And What You Should Do Instead

3) The Honest Truth About Getting Great Results With Shoulder Pain Patients And Why It Can Be So Much Easier Than You Ever Imagined!

And Much, Much More!

Get Your FREE COPY Right HERE.