My client was referred to me by his GP with a 6 month history of ‘rotator cuff’, vague yes, but a starting point perhaps.
Indeed he showed and arc of pain raising the shoulder into abduction. He had a positive Jobes empty can test, but as we know this type of test lacks validity and reliability. Nonetheless the test indicated that some shoulder structure or other did not like to be stressed in this way. But did Jobe's test reproduce my clients pain? - no, and neither did the other impingement tests which appeared positive. So was the possible impingement a secondary issue?
My client's shoulder was ‘stiff’ and generally restricted in all directions. His pain was more accurately reproduced when he actively raised his arm into about 90 degrees of abduction and then outwardly rotated at the shoulder. This reproduced ‘his pain’ which was located at the upper long head of biceps brachii region. The biceps muscle, possibly tendon is the problem? No, only mildly tender to palpate and the biceps provocations tests were negative. However when I applied a gentle anteroposterior glide to the head of the humerus his pain eased immediately and he was able to move without pain further into range.