Empty Can Test | Subacromial Pain Syndrome

Specifically, the Empty Can Test also called as Jobe test is a clinical test for diagnosing the rotator cuff tears or injury especially to the supraspinatus muscle and tendon. This test is employed in identifying supraspinatus muscle weakness, tears or tendinopathy; which are frequent sources of shoulder pain and disability.

Indication for Empty can Test

The Empty Can Test is indicated for patients presenting with:

• Aching or discomfort in the shoulder particularly when in a raised position.
• Possible rotator cuff tear or tendinopathy.
• Weakness in shoulder abduction.
• Symptoms of shoulder impingement.
• History of previous trauma or repeated use and abuse of the shoulder joint.

How to Perform Empty can Test 

Periška & Markov’s approach 

About the Test methodologies to be followed The procedures that must be followed to execute the test are mentioned below.

• Patient Positioning: Next the patient stands with their arms in the position with maximum external rotation abduced to 90 degrees in the scapular plane which is around 30 degrees away from the coronal plane.
• Arm Positioning: Patient’s shoulders are rounded in a manner that, thumbs are pointing down as though the patient is simulating a can.
• Resistance Application:During the invasion, the therapist is facing the patient.
• In this technique, the therapist descends a force on the patient’s arms with the patient counteracting it.
• Observation:The therapist watches out for signs such as pain, weakness or the clients inability to suitably hold their arm in the described position when some resistance is applied.

Assessment Outcome of  Empty can Test

• Positive Test: Difficulty experienced when applying the downward force against the physician’s hand signifies supraspinatus muscle/tendon damage, they may include a tear or tendinopathy.
• Negative Test: Specific grip strength assessment revealed strength of 4 out of 5: positive supraspinatus muscle/tendon with no felt pain or weakness.

How to Make Differential Diagnosis with Empty can Test

The Empty Can Test is useful in differentiating between:

• Rotator cuff pathology particularly the Supraspinatus muscle and/or tendon tears.
• Rotator cuff injury and also shoulder impingement syndrome.
• Tendinopathy of the rotator cuff; other shoulder disorders — bursitis, adhesive capsulitis.

Related Tests for Supraspinatus Tear 

• Full Can Test: Like Empty Can Test but done with thumbs up; this holds the supraspinatus in a less provocative position.
• Drop Arm Test: Diagnoses for full- thickness rotator cuff tear.
• Hawkins-Kennedy Impingement Test: Diagnoses subacromial impingement of the shoulder.
• Neer Impingement Test: Identifies shoulder impingement.
• Infraspinatus Test: Tests the grade of the infraspinatus muscle.

Evidence-Based Physiotherapy Researches

• Rehabilitation Strategies: Randomised trials on indications for shoulder rehabilitation programmes show the trunk, rotator cuff and scapular muscles to enhance in individuals with positive Empty Can Tests.
• Early Diagnosis and Management: There are underlying advantages of early management involving early physiotherapy as well as possible surgery in relation to rotator cuff tears.
• Advanced Imaging Techniques: Use of MRI and ultrasound in compound with clinical tests can be useful in diagnosis.
• Long-Term Follow-Up Studies: To bring more light on the matter, studies comparing the outcomes of conservative and surgical management of rotator cuff tears will be beneficial.

Key References:

1. Jain, N. B. , & Higgins, L. D. (2019). Rotator Cuff Tear and Shoulder Impingement: A succinct report of something; may be on a book, a building, a film, an exhibition etc. Sports Medicine.
2. Kim, D. H. , & ElAttrache, N. S. (2020) Rotator Cuff Tear: Summarize Section: Early diagnosis and management. Journal of Orthopaedic Surgery.
3. Burbank, K. M. , Stevenson, J. H. , & Czarnecki, G. R. (2018). Management of: Rotator Cuff Tears. American Family Physician.

Thus, it is significant for the physiotherapists to employ the Empty Can Test, incorporating the mentioned steps and insights into practice to diagnose and manage the supraspinatus muscle/tendon pathologies relying on research evidence.