Shoulder Depression Test

An overview of the shoulder and its functions

The shoulder is a complex joint that allows for a wide range of motion and is crucial in daily activities. Its primary function is to provide mobility and stability to the upper limb, allowing us to perform tasks such as reaching, lifting, pushing, and pulling.

It comprises three bones - the clavicle (collarbone), the scapula (shoulder blade), and the humerus (upper arm bone). These bones form four joints - the sternoclavicular, acromioclavicular, glenohumeral, and scapulothoracic joints. Each joint has a unique contribution to the overall function of the shoulder.

For instance, the clavicle acts as a strut to stabilize the shoulder (AAOS, n.d.), while the acromioclavicular joint allows for rotation and movement of the scapula (NCBI, 2018). The glenohumeral joint is responsible for most of the shoulder's range of motion (NCBI, 2019a), and the scapulothoracic joint works with other joints to allow entire movement (NCBI, 2019b).

The muscles, ligaments, and tendons surrounding the shoulder also play a crucial role in its function. They provide stability and support to the joint while allowing for movement. Any injury or dysfunction in these structures can cause pain and limit the shoulder's range of motion.

Common shoulder injuries and conditions

The shoulder is susceptible to various injuries and conditions due to its complex structure and extensive use. Some of the most common include the following:

Rotator cuff tears

These tears occur in one or more of the four muscles that comprise the rotator cuff - supraspinatus, infraspinatus, teres minor, and subscapularis (Mayo Clinic, n.d.). These muscles help to stabilize and rotate the shoulder joint. Rotator cuff tears can be due to injury or degeneration over time.

Shoulder impingement syndrome

This condition occurs when the tendons, bursa, or other soft tissues in the shoulder become compressed between the bones NCBI, n.d.). It can cause pain and limit movement.

Shoulder instability

This refers to conditions where the shoulder joint is not held firmly in place by its supporting structures. It can result in shoulder joint dislocation or subluxation (partial dislocation).

Frozen shoulder

Also known as adhesive capsulitis, this condition causes stiffness and pain in the shoulder joint. It is often a result of inflammation and thickening of the capsule surrounding the shoulder joint John Hopkins Medicine, n.d.).

Radicular pain

Radicular pain is chronic pain caused by irritation or compression of a nerve root in the spine (Johns Hopkins Medicine, 2023). Some radicular symptoms include numbness, weakness, and tingling in the arms or legs. This type of pain can be caused by conditions such as herniated discs, spinal stenosis, or degenerative disc disease.

Cervical radiculopathy

This condition, also known as a pinched nerve or herniated disc, occurs when nerve roots in the cervical spine (neck) are compressed or irritated. It can cause pain, numbness, and weakness that radiates down the arm (Mayo Clinic, n.d.).

The Shoulder Depression Test

The Shoulder Depression Test is a clinical examination used to assess the presence of nerve root compression in individuals with suspected cervical radiculopathy. It is one of the many shoulder-specific tests in the orthopedic physical assessment.

During this test, the patient's head is passively depressed towards the unaffected side while maintaining an upright sitting position. The examiner then applies downward pressure on the patient's shoulder while monitoring for any reproduction of pain or other radicular symptoms in the arm.

This test is based on the principle that shoulder depression increases foraminal space and reduces pressure on the nerve root, potentially relieving symptoms in cases of nerve root compression.

How to use Carepatron's Shoulder Depression Test

Our free Shoulder Depression Test makes evaluating your patients for cervical radiculopathy easy. Follow these steps to get started:

Step 1: Download the test

Get a copy of the Shoulder Depression Test using the link on this page or the Carepatron app. You can also download it from our resources library.

Step 2: Print or use the digital format

Print the test or use it in a digital format on your device. Make sure to have it ready for the clinical examination.

Step 3: Conduct the test

Follow the instructions provided in the test and perform the shoulder depression maneuver while monitoring for any reproduction of radicular pain or symptoms.

Step 4: Document results

Record any positive findings or signs during the test. This information can be used to aid in the diagnosis of cervical radiculopathy and help guide further treatment. You can also use our free Shoulder Pain Diagnosis Chart or our Shoulder Pain and Disability Index as a reference.

Interpreting the results

Positive result

A positive test result, where the patient experiences a decrease in radicular pain or symptoms during the shoulder depression maneuver, can indicate nerve root compression and cervical radiculopathy. This finding should be further investigated through other clinical tests such as the Upper Limb Tension Test, Brachial Plexus Tension Test, and Foraminal Compression Test.

Negative result

If the patient does not experience any changes in symptoms or pain during the Shoulder Depression Test, it may indicate that nerve root compression is absent. However, other diagnostic tests should still be performed to rule out other potential causes of radicular pain.

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Other useful shoulder tests

As mentioned, other clinical tests can aid in diagnosing cervical radiculopathy and nerve root compression. These include:

Shoulder subluxation test

The shoulder subluxation test involves applying downward pressure on the patient's head while they are in a seated position. A positive finding is indicated by shoulder pain or reproduction of radicular symptoms.

Shoulder abduction test

In the shoulder abduction test, the patient's arm is abducted and held at 90 degrees for one minute. The reproduction of radicular symptoms or pain indicates a positive sign.

Distraction test

The clinical exam involves gently pulling the patient's head and neck upwards while they are in a seated position. A positive finding is indicated by relief of radicular symptoms or pain. This test helps to differentiate between nerve root irritation and compression.

Provocative tests

Provocative tests provoke or reproduce pain in a specific body area. In diagnosing cervical radiculopathy, provocative tests may include applying pressure on specific areas of the spine, moving the head and neck in different positions, or performing specific tasks.

Utilizing the upper limb tension test can help in assessing nerve tension and diagnosing potential neural issues in the upper extremities. The shoulder abduction test is useful for evaluating shoulder muscle strength and functionality. Employing the shoulder pain and disability index allows for measuring the impact of shoulder pain on daily activities and overall function.

Additionally, the shoulder pain diagnosis chart aids in identifying specific pain patterns and their underlying causes, while the shoulder subluxation test helps in detecting shoulder instability. Combining these assessments provides a thorough evaluation of shoulder health and guides targeted treatment.

Improving shoulder health

Here are some tips for your patients to improve and maintain shoulder health:

Stretches and exercises

Incorporating shoulder stretches and exercises into a daily routine can help improve the shoulders' range of motion, strength, and flexibility. Examples include shoulder rolls, arm circles, and rotator cuff strengthening exercises.

Proper posture

Encouraging proper posture is vital for maintaining healthy shoulders. Slouching or hunching over can strain the shoulders and lead to pain or injury. Remind patients to sit or stand up straight, with their shoulders relaxed and aligned with their ears.

Avoiding repetitive movements

Repetitive movements, such as lifting heavy objects or performing the same tasks repeatedly, can strain the shoulders and increase the risk of injury. Encourage patients to take breaks and switch up tasks to avoid overuse of the shoulder muscles.

Using proper form during physical activity

Proper form is crucial for preventing shoulder injuries, whether playing sports or performing everyday activities. Remind patients to use their legs and core when lifting heavy objects and to practice an appropriate form when participating in physical activities that involve the shoulders.

References

American Academy of Orthopaedic Surgeons. (n.d.). Sternoclavicular (SC) Joint Disorders. OrthoInfo. https://orthoinfo.aaos.org/en/diseases--conditions/sternoclavicular-sc-joint-disorders/

Johns Hopkins Medicine. (n.d.). Frozen shoulder. Johns Hopkins Medicine Health Library. https://www.hopkinsmedicine.org/health/conditions-and-diseases/frozen-shoulder

Johns Hopkins Medicine. (2023, September 15). Radiculopathy: Conditions & Diseases. Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/radiculopathy

Mayo Clinic. (n.d.). Rotator cuff injury. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/rotator-cuff-injury/symptoms-causes/syc-20350225

National Center for Biotechnology Information. (n.d.). Shoulder impingement syndrome. Ihttps://www.ncbi.nlm.nih.gov/books/NBK554518/

National Center for Biotechnology Information. (2018). Sternoclavicular joint injuries. Ihttps://www.ncbi.nlm.nih.gov/books/NBK499858/

National Center for Biotechnology Information. (2019). Sternoclavicular joint infections. https://www.ncbi.nlm.nih.gov/books/NBK536933/

National Center for Biotechnology Information. (2019). Sternoclavicular joint septic arthritis. https://www.ncbi.nlm.nih.gov/books/NBK537258/