Reply To: Its Time to Put Special Tests for RC Related Shoulder Pain Out to Pasture

[Steven Lagasse]

Anna,

Barrett answered your question on using special testing as an objective asterisk quite nicely. I agree with his thoughts.

Regarding your question on whether or not this article changes my thoughts on special questions – I’m unsure. At best, it reminds me where special tests stand in the clinical examination hierarchy- closer to the bottom rather than the top.

I did resonate with your quote below and felt I would speak to it:

“I feel like my pattern recognition is based a lot more on specific subjective complaints, functional assessment, ROM, and resisted testing with less of an emphasis on special testing. To be honest at times I feel like I am just doing it because that is what we learned but don’t put a whole lot of stock into the findings…”

Regarding shoulder special tests, beyond impingement and instability, I too feel as though I perform these tests for the sheer sake of doing. This type of practice has not been helpful. I have brought this to AJ’s attention during mentorship sessions. He will force me to reflect, asking questions such as: Why do you think the test isn’t helpful? Do you understand the test and/or know what it is assessing for? From there it’s back off to the drawing board. This requires a fair amount of humility but has been quite helpful in progressing me from blindly doing to actively interpreting. This is still something I work on daily. Perhaps this insight will be helpful. You’re certainly not alone!