REIDER PART 159

Charter 2_Shoulder and Upper Arm 49

Figurę 2-60. IlornbloweFs sign. A, Normal. B, Abnormal.

Figurę 2-61. A and B, Subscapularis liftoff test.

A    B

against the abdomen, with the arm in the coronal piane and the elbow flexed to 90 degrees. The examiners hand is placedbetween thepatient s hand and abdomen so that the strength of the subsequent pressure ćan be felt. The patient is then instructed to press the hand firmly against the abdomen. Normally, the patient should be able to exert strong pressure. In the presence of significant subscapularis weakness> the pressure will be weak and the patient will often move the elbow forward from the coronal piane in an attempt to gain morę leverage. (Fig. 2-63)

Passive Rotation Test. Passive rotation in the abducted position may provide supporting evidence for subacro-mial pathology. To perform this test on the left shoulder, the examiner stands behind the patient. The patient is asked to abduct the left shoulder to 90° with the elbow flcxed. The examiner then grasps the patient’s left elbow with his or her left hand, and asks the patient to relax eon troi of the arm. The examiner^>s right hand is placed on the patient s shoulder. The examiner then rotates the patients shoulder through as wide an arc of internal and external rotation as possible while palpating for soft tis-sue crepitus with the right hand (Fig. 2-64). This soft tis-sue crepitus, often described as “popping,” may reflect a hypertrophied subacromial bursa or a toru irregular rotator