CHT Exam Prep: How to Understand Rotator Cuff Testing For Shoulder Impingement - Hand Therapy Secrets

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CHT Exam Prep: How to Understand Rotator Cuff Testing For Shoulder Impingement

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Why don’t OTs treat more shoulders?

I understand that you might not be given the “opportunity” at your job.

I understand that you might not “know everything” to be as effective as you would like.

What if you CREATED your own opportunity?

I know that just about every hand, wrist, elbow patient of mine – has or will develop shoulder issues, especially if they are coming to you with chronic issues.

What if you PRACTICED treating non-shoulder patients and checking for shoulder issues? You don’t have to know everything to get started. Because when you came out of Occupational Therapy school, you didn’t know “everything” and still started, didn’t you?

Watch this video – it’s a clip from my Hand Exam Prep program, a lecture series discussing the major RTC testing you should be aware of.


After observing the shoulder, it’s then key to go into testing. You test for motion. But then you need to rule in and rule out other problems to DECIDE on the best treatment method.

It’s not a cookie-cutter program, but you can definitely have your key go-to movements that get your patients results fast.

That doesn’t mean they keep them…it means that if they come back to you in the next visit…you get another chance to help them with their problem, and YOU get another chance to practice your skills.

I love shoulders! This is what I teach my own therapists….and what I want to share with you.

It is possible for you to be able to treat even more patients than ever before.

It’s up to you to let people know that Occupational Therapists can and do treat shoulders effectively. AND it’s NOT about going out there and talking about Occupational Therapy and “occupation.”

It’s about being able to be confident to say that you can and then prove it.

My favorite move to help the shoulder fast is to go right to the thoracic spine….and my favorite home exercise move is to clean the wall.

The most important thing is understanding why you’re doing a test. In the video, I go over the impingement signs. When it’s a rotator cuff, you’re going to look for impingement signs, and there are two types of tests. You can do the Jobe’s test or the empty can. You’re looking for impingements, or you’re looking for tears. Then there’s the belly-press test, and then you will look for the lag signs.

In Rehab of The Hand Book, when they mention the lag sign, it is referring to when you’re going to place someone in external rotation, and they can’t hold that external rotation. It’s most likely an infraspinatus tendon tear.

The other lag that they talk about is a hornblower’s lag, and the hornblower’s lag is where there’s going to be an abduction, and you’re trying to get them to go into an external rotation in that abduction position as the hornblower’s test. And if they can’t do that, that’s more indicative of a teres minor tear.

I think that’s important because they could ask you certain questions like what tests would be best if you suspected a tear here. And then they’re going to give you three or four different tests, and you can rule two out, but what if one of them was these lag tests? But one is going to be more indicative of an infraspinatus tear, which is the external rotation one, or a hornblower’s, which is more of a teres minor.

So when reading, that’s what jumped out at me. And how if I think through what’s important, how they’re going to ask me, that’s how you know, you’re somehow able to apply it.

When you understand, “Oh, okay, this muscle helps with external rotation, which test is going to test external rotation?” So then, when you read the test questions, it’s going to come down to, “Okay, well, that test is going to test for external rotation. I know these two muscles do external rotation.” The infraspinatus and the teres minor do external rotation, whereas the Subscap I know does internal rotation. If that’s one of the questions, and the question is all about external rotation, then Subscap is out.

Want Help Preparing for the CHT Exam?

Our Hand Exam Prep program keeps you accountable and focused and gives you the support to pass the CHT exam! Get more details HERE. 

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Hoang Tran

“I help Occupational Therapists develop their skills and grow their confidence in Hand Therapy. No matter where you are on your journey, build a happy and fulfilling career of your dreams. I’ll help you.”