Thus, what might initially be regarded as a limited movement can be proved to be a painful arc with full range, which has completely different diagnostic implications. The apparent limitation may be overcome by persistence, and it may be possible for the patient to then get beyond the painful moment. If the examiner has the impression that passive elevation or medial rotation is limited, it is important to insist that the movement is gently continued, otherwise the patient may voluntarily stop the movement too early, due to pain. This has the same meaning as a painful arc on the way up. Occasionally the patient may experience the pain at mid-range only on the way down, or even on passive medial rotation. Indeed, some patients abduct until they feel the pain start at mid-range and then bring the arm in front of the body to avoid further impingement. Sometimes the patient tries to avoid the painful moment by changing the direction of the elevation when the pain is felt. This is due to the muscular activity, which pulls the humeral head closer to the acromion during active elevation. Fig 1 Site of impingement (blue) in painful arc.Īn arc on elevation is usually most pronounced during the active movement, and more on the way up than on the way down.
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