The Painful Arc in Shoulder Examination: Clinical Relevance and Testing Positions
The painful arc is a classic clinical sign observed during shoulder examination that helps localize and identify specific shoulder pathologies. It refers to pain that occurs during a defined range of active arm elevation, typically between 60° and 120° of abduction, and is most commonly associated with subacromial impingement or rotator cuff pathology, particularly involving the supraspinatus tendon.
Mechanism and Significance
During arm elevation, the supraspinatus tendon and the subacromial bursa pass beneath the acromion. In cases of tendinopathy, bursitis, or anatomical narrowing (e.g., bone spurs), these structures can become compressed, producing pain within a specific arc of movement. The presence of a painful arc suggests impingement of subacromial structures, although it can also be seen in other conditions like calcific tendinitis or partial rotator cuff tears.
Changing the position from we perform the test movement can also be interesting.
