Internal Rotation Resistance Stress Test

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 Internal Rotation Resistance Stress Test

What is Internal Rotation Resistance Stress Test?

Internal Rotation Resistance Stress Test is a supplement to a positive impingement test to differentiate an outlet impingement in the classical sense from a non-outlet (internal) impingement as a result of intra-articular pathology.

How it’s Performed?

What does a positive Internal Rotation Resistance Stress Test mean?

Sensitivity & Specificity

A prospective study by Zaslav1 to assess the accurecy of Internal Rotation Resistance Stress Test in differentiating between outlet impingement in the classical sense and a non-outlet (internal) impingement, he found the Sensitivity & Specificity as following:


Non-outlet (Internal) Impingement

In Non-outlet (Internal) Impingement, internal contact of the rotator cuff occurs with the posterosuperior aspect of the glenoid when the arm is abducted, extended, and externally rotated as in the cocked position of the throwing motion.

It often occurs in throwers who have lost internal rotation of the shoulder. This loss causes the center of rotation of the humeral head to move upward so that the contact between the rotator cuff and the biceps tendon attachments increases.

Arthroscopic findings include partial rotator cuff tears, posterior and superior labral tears, and anterior shoulder laxity.

Early in the course of the condition, aggressive physical therapy with attention to regaining internal rotation and rotator cuff strengthening often is successful.

internal impingement
Internal impingement


  1. K R Zaslav: Internal rotation resistance strength test: a new diagnostic test to differentiate intra-articular pathology from outlet (Neer) impingement syndrome in the shoulder. J Shoulder Elbow Surg. Jan-Feb 2001;10(1):23-7. doi: 10.1067/mse.2001.111960. PMID: 11182732
  2. Clinical Tests for the Musculoskeletal System, Third Edition book.
  3. Mark Dutton, Pt . Dutton’s Orthopaedic Examination, Evaluation, And Intervention, 3rd Edition Book.
  4. Millers Review of Orthopaedics, 7th Edition Book.
  5. Campbel’s Operative Orthopaedics 13th Edition Book.

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