Painful arc, a diagnostic tool ?
A painful arc is a clinical item presenting itself as a painful section in a movement, inbetween two painfree sections.
In the shoulder (e.g. active arm elevation of passive rotation) it is a valuable localizing sign pointing in the direction of different specific lesions :
there could be a painful arc in case of a supraspinatus lesion tenoperiosteal, an infraspinatus tenoperiosteal lesion, a subscapularis lesion tenoperiosteal, a lesion of the deep part of the acromioclavicular joint or in case of a chronic subdeltoid bursitis.
In the spine (e.g. on flexion in standing or SLR) it is a typical sign for an internal derangement, excluding e.g. SI- or facet-involvement. It is not only typical for an internal derangement but it also shows it is a small reducible derangement.
(Part I, p41-42, 196)
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