Pain provocation test is used to assess for nerve root impingement that results from encroachment on structures within the intervertebral foramen and shoulder joint performance test. To perform the test, with the patient sitting, the therapist clasps both hands across the top of the patient’s head and applies a downward force on the head.
The shoulder is abducted to 90 to 100 degrees on to the side with the elbow flexed 90 degrees. The arm is then maximally externally rotated and while maintaining this position the arm is then maximally pronated and supinated. The test is positive if maximal pronation elicits or worsens pain.
The authors (Mimori et a11999) observed that when using the anterior apprehension test in athletic patients with shoulder injuries to look at glenohumeral instability some patients noted pain during the test and therefore the severity of pain varied with the position of
the forearm. They hypothesized that this difference might be used for diagnosing superior labrum lesions in patients with throwing injuries of the shoulder.
Test
The patient is assessed in sitting with their arm in 90-100° abduction. The arm is passively externally rotated maximally with the forearm in maximum pronation or supination.
Reported as positive when pain is provoked only within the pronated position or when pain is more severe during this position.
Mimori et al (1999) compared the results of the pain provocation test with MRA (32) and arthroscopy (15) in 32 throwing athletes.
In 22 patients detachment of the superior labrum was observed on arthrogram and every one of them had positive results on the new pain provocation test. 11 of 15 patients were found to possess SLAP II lesions arthroscopically and every one had positive pain provocation tests. the opposite 4 patients didn’t have superior labral tears and therefore the pain provocation test was negative.
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