Execution
- 1Position the patient standing or sitting with the shoulder elevated in the scapular plane.
- 2Abduct the arm to approximately 90° and keep the shoulder externally rotated so the thumb points upward.
- 3Ask the patient to hold the position while applying downward resistance to the distal arm.
- 4Observe for pain, weakness, or inability to maintain the arm position.
- 5Compare the response with the empty can position and the opposite shoulder.
Positive outcome
Pain or weakness during resisted elevation in the thumb-up position is positive. The full can position is intended to test supraspinatus while provoking less pain than the empty can position.
Studies
| Study | Reliability | Sn | Sp | LR+ | LR− |
|---|---|---|---|---|---|
| Itoi et al. (1999) | NA | 74 | 74 | 2.96 | 0.31 |
| Jain et al. (2017) | NA | 70 | 81 | 3.68 | 0.37 |
CommentMagee notes that some authors prefer the thumb-up position because it may better preserve supraspinatus contraction with less pain inhibition. Diagnostic accuracy is usually modest-to-moderate rather than definitive. It is often more comfortable than empty can and may be better when pain limits effort.
Moderate Clinical Value