painful arc in the shoulder

When you find a "painful arc"?

You could define a painful arc as a painful passage during a movement, active or passive, inbetween two painfree passages.

This is found very often in the shoulder and is considered being a “localizing sign”: im combination with other tests from the basic examination it gives accessory information about the presumeable localisation of the lesion.

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In the shoulder we can find a painful on active elevation or on medial rotation.  Very often that also points in the direction of a chronic subdeltoid bursitis.

Of course, in case of a supraspinatus, infraspinatus, subscapularis or biceps tendinosis it can also occur.

Painful arc on shoulder elevation

In exceptional cases the PA cannot be detected in an active way (e.g. because the movement is too painful), but only in a passive way.  

In that case a severe symptomatic calcification of the supraspinatus might be suspected (that’s an empirical finding).

This can also be found during the straight leg raise test and is a typical finding pointing in the direction of a symptomatic small lumbar internal derangement.

Painful arc on straight leg raise test