Subacromial Bursitis

Subacromial bursitis is a condition caused by inflammation of the bursa that separates the superior surface of the supraspinatus tendon (one of the four tendons of the rotator cuff) from the overlying coraco-acromial ligament, acromion, and coracoid (the acromial arch) and from the deep surface of the deltoid muscle.

Anterior Neck Flexors Strength Test

Purpose:
To asses the strength of the neck flexors (SCM, anterior scalene, supra and infrahyoids, longus colli and capitis, and rectus capitis anterior)

Procedure:

  • Patient is supine
  • Patient abducts arm to 90°, flexes the elbows to 90°, and rest their dorsal hands on the table.
  • Patient tucks chin, and then lifts head off the table.
  • Patient keeps the head lifted off the table (Grade 3). Patient resists therapist posteriorly-directed pressure (Grade 5)

Positive Sign:
Weakness of Anterior Neck Flexors if Patient is unable to keep the neck in flexion against gravity or the therapist’s pressure.

Anterolateral Neck Flexors Strength Test

Purpose:
To asses the strength of the Anterolateral Neck Flexors (SCM and scalene on one side).

Procedure:

  • Patient is supine
  • Patient abducts arm to 90°, flexes the elbows to 90°, and rest their dorsal hands on the table.
  • Patient rotates the head away from the side being tested. Therapist stabilizes the side being tested.
  • Patient lifts the head into slight flexion and hold it against gravity.
  • Patient keeps the head lifted off the table (Grade 3).
  • Therapist holds the temporal region on the side being tested.
  • Therapist pushes in an oblique posterolateral direction, away from the tested side.

Positive Sign:
Weakness of the Anterolateral Neck Flexors if the patient is unable to keep the neck in flexion against gravity or the therapist’s pressure.

Cervical Compression Test

(for patients who cannot rotate or extend their head)

Testing For:
Compression of cervical nerve root or facet joint irritation in the Lower Cervical Spine

Procedure:

  • Patient is seated.
  • Patient’s head is in neutral.
  • Therapist stands behind patient.
  • Carefully apply compression downward on the head of the patient.

Positive Sign:
Radiating pain or other neurological signs in the same side arm (nerve root) and/ or pain local to the neck or shoulder (facet joint irritation).

Cervical Distraction

Purpose:
To relieve the pressure on the cervical nerve roots (may be used after Spurling’s or Cervical Compression Tests)

Procedure:

  • Patient is supine or seated. Patient’s head is in a neutral position at all times throughout the procedure.
  • Therapist grasps the patient’s head at occiput and temporalis. One hand on either side of the head.
  • Slowly traction the patient’s head in a superior direction. Maintain the traction for at least 30 seconds.

First Rib Mobility Test

Purpose:
To test the mobility of Rib 1

Procedure:

  • Patient is seated.
  • Patient fully rotates their head away from the side being tested.
  • Patient then fully flexes the head to their chest.

Positive Sign:
Patient has limited neck flexion. The cause for the hypomobilty may be tight scalenes