In the painful arc test, pain occurring during which portion of arm elevation most strongly suggests subacromial involvement?

In the painful arc test, pain occurring during which portion of arm elevation most strongly suggests subacromial involvement?

• A. Pain between approximately 60 and 120 degrees supports subacromial involvement.
• B. Pain at full overhead elevation indicates biceps tendon pathology.
• C. Pain during initial elevation indicates glenoid labrum injury.
• D. No pain throughout elevation excludes subacromial pathology.

Answer: (A)

The test looks for subacromial impingement by finding where in the arc of arm elevation pain occurs. When the arm is raised, the subacromial space narrows most around 60–120 degrees of abduction, so the rotator cuff tendons (especially the supraspinatus) and subacromial bursa can be pinched between the humeral head and the acromion. This mid-range pain is the hallmark of subacromial involvement because it reflects this compression, whereas pain outside this range is less specific for impingement. Pain at full overhead elevation could be due to other issues, such as biceps tendon or other structures, and pain only during initial elevation points toward different intra-articular concerns like a labral problem. A lack of pain throughout elevation does not definitively rule out subacromial pathology, since symptoms can be absent in some cases.

The test looks for subacromial impingement by finding where in the arc of arm elevation pain occurs. When the arm is raised, the subacromial space narrows most around 60–120 degrees of abduction, so the rotator cuff tendons (especially the supraspinatus) and subacromial bursa can be pinched between the humeral head and the acromion. This mid-range pain is the hallmark of subacromial involvement because it reflects this compression, whereas pain outside this range is less specific for impingement.

Pain at full overhead elevation could be due to other issues, such as biceps tendon or other structures, and pain only during initial elevation points toward different intra-articular concerns like a labral problem. A lack of pain throughout elevation does not definitively rule out subacromial pathology, since symptoms can be absent in some cases.