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Painful Arc Test
The painful arc test is used to identify a number of shoulder conditions including shoulder impingement and acromioclavicular joint pathology. This test is also called the painful arc sign. To perform this test, ask the patient to abduct the arm from the resting position alongside the body. Note the onset of pain and at what angle of elevation it arises and at what angle it disappears.
Pain felt in an arc between 60 and 120 degrees is suggestive of a rotator cuff disorder including impingement syndrome. This occurs because with glenohumeral joint abduction, the space between the humerus and the acromion reduces as it approaches 90 degrees of elevation. As the humerus elevates above this point, the space between the humerus and the acromion reopens. This means that any impingement between the humerus and the acromion will be at its maximum at about 90 degrees.
Pain arising in the final stages of elevation and persisting to the end of range, is suggestive of a disorder of the acromioclavicular joint. This is because the capsule of the acromioclavicular joint reaches maximum tension towards the end of abduction and remains under full tension to the end of range. Another cause of pain arising in the final stage of abduction is involvement of the cervicothoracic spine.
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