Internal Rotation Resistance Stress Test

What is the "Internal Rotation Resistance Stress Test" used for?

• Differentiate between internal and classic outlet impingement

How to perform the "Internal Rotation Resistance Stress Test"?

• The test is performed with the patient seated and the examiner standing behind the patient.
• The patient’s arm is positioned in 90 degrees of abduction in the coronal plane and approximately 80 degrees of external rotation.
• A manual isometric muscle test is performed for external rotation and compared with one for internal rotation in the same position.

What is the positive result?

• If a patient with a positive impingement sign has good strength in external rotation and weakness in internal rotation, the test is positive.
• A positive internal rotation resistance stress test suggests internal impingement,
• and a negative test (more weakness in external rotation) suggests classic outlet impingement.

Test Accuracy

• Sensitivity: 88 %
• Specificity: 96 %

References

• Campbel’s Operative Orthopaedics Book
• Tennent, T Duncan et al. “A Review of the Special Tests Associated with Shoulder Examination.” The American Journal of Sports Medicine 31 (2003): 154 – 160.