Painful Arc Test of Shoulder for Supraspinatus Impingement

The Painful Arc Test is commonly used in orthopedic examination of the shoulder to test for impingement of the supraspinatus tendon and/or the subacromial bursa underneath the acromion.

Anatomy of the Shoulder Complex
Diagram of the shoulder including the supraspinatus and subacromial bursa
National Institute Of Arthritis And Musculoskeletal And Skin Diseases (NIAMS); SVG version by Angelito7, Public domain, via Wikimedia Commons

Involved Structures

  • supraspinatus
  • subacromial bursa
  • acromioclavicular joint

Starting Position

This test is performed with the patient in sitting or standing. The patient’s arm is in neutral rotation.

Test Movement

In this position, the patient fully abducts their arm in the scapular plane.

Positive Test

The Painful Arc Test is considered positive for supraspinatus impingement if the patient reports pain between 60 degrees and 120 degrees of abduction. Pain should reduce after 120 degrees of abduction. If the patient instead reports pain at the end of abduction, acromioclavicular joint dysfunction is indicated.

Accuracy of Test

The Painful Arc Test for subacromial impingement is considered to be a fairly accurate test. Positive likelihood ratio = 2.25; 95% CI, 1.33-3.81.

Reference: Reliability and diagnostic accuracy of 5 physical examination tests and combination of tests for subacromial impingement

Video Demonstration

>> Return to the list of Orthopedic Tests of the Shoulder

Here are some other tests for rotator cuff pathology:

The Bare Minimum: Donatelli Shoulder Method Assessment and Treatment

The Bare Minimum: Donatelli Shoulder Method is an evidence based book that describes the assessment and treatment techniques of Dr. Robert Donatelli and Donn Dimond. It includes mobility testing, strength tests, and special tests along with mobilization techniques and exercises for treating shoulder pathophysiology.

Special Tests for Orthopedic Examination

First published more than 20 years ago, Special Tests for Orthopedic Examination, now in its Fourth Edition, continues to follow the authors’ initial goals of providing a simple, pocket-sized manual for practical learning purposes.

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