PAINE #PANCE Pearl – Orthopaedics



Question

57yo woman comes into clinic complaining of a six-month history of right shoulder pain. She states that the pain is worse with overhead activities of the shoulder and when she is lifting and pulling with that arm. She has been more playing more tennis with her husband during this time as well, but has never had any other issues with this shoulder or arm before. She also reports painful arc of shoulder rotation with clicking that she feels on the anterior part of her shoulder. On physical examination, she has a negative drop arm and empty can test with no significant pain on resisted external rotation.

  1. What are two (2) maneuvers that you should perform next?
  2. If these are positive, what would the most likely diagnosis be?


Answer

Given the history and negative findings on rotator cuff maneuvers, the next two maneuvers shoulder be the Yergason and Speed tests. If the patient has pain with either of these then it suggests biceps tendonitis as the cause of their shoulder pain. Anatomically, the origin of the long head of the biceps is near the insertion of the supraspinatus tendon. This is why you always assess biceps tendonopathy in patient presenting with shoulder pain.

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