The Shoulder

Help - Examination

Several resisted movements are positive

4. The pain is caused by"transmitted stress"

It may happen that isometric movements indirectly provoke pain in other structures than the ones that are supposed to be tested. Cyriax called this phenomenon "transmitted stress".

In the shoulder there are three classical examples of transmitted stress:

During the resisted extension of the elbow, the contraction of the humerus pulls the head of the humerus towards the acromion. If a lesion lies between one of the tuberosities and the coracoacromial roof it can be pinched. Therefore pain on resisted extension of the elbow has usually the same meaning as a painful arc.
Resisted adduction of the arm. The strong actions of latissimus dorsi and pectoralis major pull indirectly on the AC joint. Resisted adduction will therefore very often provoke local shoulder pain in chronic strain of the acromio-clavicular joint
Resisted abduction, executed with the humerus hanging straight along the trunk, will also provoke a strong upwards movement of the humerus; - the action of the contracting deltoid pulls the humeral head towards the acromial roof . All structures between the coracoacromial roof and the humerus may become compressed. iI is therefore adviseable to start the resisted abduction movement on a slightly abducted arm (about 20-30° of abduction ), or to perform the movement during slight axial traction.