First of all, this author is definitely on a soapbox…

Anna/Steve – totally agree, I usually do the tests but don’t put a whole ton of stake in them

Anna/Barrett – also agree to the point about identifying a specific structure at fault. In some body regions I think this is very appropriate but for the shoulder, with as interconnected as everything is, I’m not sure it’s appropriate to attempt to identify one specific structure at fault. I find myself spending SO MUCH TIME trying to identify a structure, that I often wonder if I had just started treating the impairments if they would be getting better faster…

All in all, I think special tests DO have a place in a shoulder evaluation. It’s a cluster just like everything else in PT is, and within the cluster there is a hierarchy of information. Special tests are lower on that totem pole for me than some other subjective/objective info as Taylor mentioned. I think I tend to use special test results broadly rather than using them to point to a specific tissue at fault. For example, I may think “this shoulder does not like compression” with the crank test or “this shoulder does not like internal rotation” with Hawkins Kennedy.

Lastly, to the author’s point about imaging: isn’t it true for most body regions that imaging findings don’t correlate to pain? I think this speaks to a more comprehensive approach to an evaluation, taking into consideration pain neuroscience and other psychosocial factors. Again, just more data points for the cluster…