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Subscapularis muscle Subscapularis tendon, upper half strong muscle that, unless it is severely injured, it does not test positively during the most commonly used test to locate this injury. However, there are different assessment tests that help you clearly differentiate one injury from another. While performing the assessment tests for the subscapularis, try to ignore exactly where the client feels pain, as long as it is felt in the upper arm and shoulder. While testing for this injury, the client will often feel pain in strange places, like down the back of the upper arm in the triceps area, within the arm, at the back of the deltoid muscle, or occasionally far under the scapula. The most important positive test for this injury is pain felt on resisted medial rotation (Test 1). This test is called the "major indicator," because it gives you the most important information you are seeking. There are also secondary or auxiliary tests that can help you refine the area of injury. I want to give you a clear overview of how to differentiate each injury. For greater detail, you can see my previous articles on these injuries or the hour- long webinars devoted to each one ("Shoulder Series #1: Infraspinatus Tendinitis," June/July 2004, page 100; "Shoulder Series #2: Supraspinatus Tendinitis," August/ September 2004, page 104; "Shoulder Series #3: Subscapularis Tendinitis," October/November 2004, page 98). Subscapularis Major Indicator—Resisted Medial Rotation To efficiently test for subscapularis tendinitis, the client's upper arm must be fixed into her body. To stabilize the upper arm into the body, place one hand on the client's upper arm just above the elbow and press the upper arm into the body. With her arm bent in front at a right angle, place your other hand on the inside of the client's wrist. Now, ask the client to pull the wrist toward her stomach while you pull outward with equal force, maintaining the 90-degree angle to the abdomen. Be sure to keep the upper arm into the body to stabilize the shoulder or the test will not read correctly. If this test causes no pain, begin the test from a stretched position by laterally rotating the arm to 135 degrees (Test 1A), then to 180 degrees (Test 1B). From these new starting positions, have the client pull toward the abdomen. Each test variation stretches the muscle a little bit and progressively puts more stress on the tendon. This principle is important to keep in mind while testing all tendon injuries. B Test 1 Subscapularis tendon, lower half A Celebrate ABMP's 25th anniversary and you may win a refund on your membership. ABMP.com. 109