A client reports pain over the top of the shoulder when pressing, reaching across the body, pushing through the arm, lying on the shoulder or returning to gym-based upper-limb loading. The Resisted AC Joint Extension Test may reproduce familiar localised AC joint pain by loading the shoulder into resisted extension.
The test should not be explained as confirming an AC joint sprain, arthritis or separation on its own. A better interpretation is that it documents whether a specific resisted shoulder position reproduces familiar pain over the AC joint region.
The Resisted AC Joint Extension Test is a shoulder pain provocation test used when AC joint involvement is suspected. The client’s shoulder is positioned in flexion, then the examiner applies resistance as the client attempts to extend the arm.
The test is considered meaningful when it reproduces the client’s familiar localised pain over the AC joint region. General shoulder discomfort, posterior shoulder pain, muscular effort or vague upper-limb discomfort should not automatically be recorded as a positive AC joint result.
The test is used when the clinical question involves possible AC joint contribution to shoulder pain.
It may be useful when the client reports symptoms during:
Horizontal pressing
Bench press
Push-ups
Dips
Cross-body movements
Reaching across the body
Lying on the affected shoulder
Contact or impact to the shoulder
Upper-limb loading tasks
The test may help document pain behaviour and guide further assessment of AC joint tenderness, cross-body loading, pressing tolerance, shoulder ROM, strength and functional loading.
The test assesses pain response over the AC joint during resisted shoulder extension.
It does not isolate one structure. A positive result may reflect AC joint sensitivity or load intolerance, but it does not confirm a specific tissue source, grade of injury, degenerative change or structural diagnosis.
This test may be useful for clients with pain at the top of the shoulder during pressing, pushing, cross-body movements, overhead loading, contact sport, gym training or work tasks involving upper-limb loading.
It may also be useful when the professional wants to compare AC joint provocation tests with broader shoulder findings such as ROM, strength, functional tolerance and symptom location.
Use this test when resisted shoulder extension can be performed safely and the clinical question involves AC joint pain provocation.
It is most useful when the client’s symptoms are localised around the AC joint and the professional wants to determine whether a resisted extension position reproduces familiar pain.
Use caution with acute trauma, suspected fracture, high-grade AC joint injury, severe pain, visible deformity, recent surgery, instability, high irritability or inability to tolerate resisted shoulder movement.
Avoid forcing the test if the client guards, reports sharp escalation of pain, cannot position the arm safely or has symptoms that suggest the test is not appropriate at that time.
Chair or standing assessment space
Pain and symptom scale
Measurz recording workflow
Optional comparison side notes
Optional video if movement quality or compensation needs to be reviewed
Position the client sitting or standing with the trunk upright.
The tested arm is raised forward to approximately 90 degrees of shoulder flexion, depending on the protocol used and client tolerance.
Stand beside or slightly behind the client so you can control the arm position and apply resistance safely.
Support or guide the distal humerus, forearm or wrist depending on the setup. The other hand may stabilise the shoulder girdle or trunk if required.
Control the trunk and scapular region as needed so the client does not rotate, lean or compensate during the resisted movement.
Ask the client to push the arm backwards into shoulder extension while you resist the movement. The resistance should be controlled and strong enough to provoke the test position without forcing or overpowering the client.
Ask the client to report pain location, intensity, quality and whether the symptoms are familiar.
A positive finding is reproduction of familiar localised pain over the AC joint region during resisted shoulder extension.
A negative finding is no familiar AC joint pain during the resisted movement.
Stop if pain increases sharply, guarding occurs, the client cannot maintain the position, symptoms become unacceptable or the test cannot be performed with control.
Do not force the shoulder into position or apply sudden resistance. Record whether pain is localised to the AC joint or whether symptoms are more general, posterior, muscular or non-familiar.
A positive Resisted AC Joint Extension Test may support AC joint pain provocation reasoning when it reproduces familiar, localised pain over the AC joint.
It does not confirm a specific AC joint diagnosis by itself. Pain may relate to AC joint sensitivity, previous trauma, degenerative change, local tissue irritation, load intolerance or other shoulder contributors.
A negative test does not exclude AC joint involvement, especially if symptoms only occur under heavier loads, fatigue, sport-specific positions or cross-body loading.
The Resisted AC Joint Extension Test has been studied as part of AC joint physical examination research. Reported diagnostic values have included:
Sensitivity: 72%
Specificity: 85%
These values suggest the test may provide useful information when AC joint involvement is suspected, but it should not be used in isolation. It is best interpreted with other AC joint tests, symptom location, palpation, history, comparison side and functional loading.
A cluster of AC joint tests may improve interpretation, but even test clusters should be interpreted cautiously and matched to the client’s full presentation.
Reliability depends on consistent shoulder position, resistance direction, resistance intensity, symptom criteria and examiner handling.
The test is more meaningful when the positive finding is defined clearly as familiar, localised AC joint pain rather than general shoulder discomfort. Validity is limited when the test is used as a stand-alone diagnostic tool or when any pain is treated as positive.
Common errors include applying sudden resistance, failing to stabilise the trunk, recording general shoulder discomfort as positive, ignoring pain location, failing to compare sides and using the test to diagnose AC joint pathology on its own.
Limitations include variable resistance force, symptom overlap with other shoulder conditions, pain irritability, examiner technique differences and limited single-test certainty.
Use the Resisted AC Joint Extension Test to document whether resisted shoulder extension reproduces familiar AC joint pain.
It is most useful when combined with AC joint palpation, Cross-Body Adduction Test, O’Brien’s Active Compression Test, shoulder ROM, pressing tolerance, push-up or bench press symptoms and upper-limb strength testing.
Record test name, side tested, result, pain score, symptom location, symptom quality, shoulder position, resistance direction, comparison side, guarding, compensation, confidence in result and reason for stopping.
Useful notes include whether pain was localised to the AC joint, whether symptoms were familiar, whether pain was muscular or general, whether the client compensated through trunk movement and whether the result matched other AC joint findings.
Add related findings such as AC joint palpation, Cross-Body Adduction Test, O’Brien’s Active Compression Test, shoulder ROM, bench press tolerance, push-up tolerance and overhead symptoms.
Cross-Body Adduction Test
O’Brien’s Active Compression Test
AC Joint Palpation
Paxinos Test
Shoulder ROM Tests
Shoulder Strength Testing
Bench Press Repetition Maximum Test
Push-Up Assessment
Hawkins-Kennedy Test
Neer’s Test
It assesses whether resisted shoulder extension reproduces familiar localised pain over the AC joint region.
A positive finding is reproduction of the client’s familiar localised AC joint pain during resisted shoulder extension.
No. It may support AC joint pain provocation reasoning, but it does not diagnose a specific AC joint condition on its own.
No. The result is more meaningful when pain is familiar and localised to the AC joint region.
No. The resistance should be controlled and stopped if symptoms escalate or the client cannot tolerate the position.
Record side, pain score, symptom location, shoulder position, resistance direction, comparison side, compensation and whether symptoms were familiar.
The Resisted AC Joint Extension Test is an AC joint pain provocation test.
A meaningful positive result should reproduce familiar localised AC joint pain.
It does not diagnose a specific AC joint condition on its own.
Interpret it with AC joint palpation, cross-body loading, O’Brien’s test, ROM, strength and functional findings.
Measurz should capture side, pain score, symptom location, test position, resistance direction and test tolerance.
Chronopoulos, E., Kim, T. K., Park, H. B., Ashenbrenner, D., & McFarland, E. G. (2004). Diagnostic value of physical tests for isolated chronic acromioclavicular lesions. The American Journal of Sports Medicine, 32(3), 655–661. https://doi.org/10.1177/0363546503261723
Gismervik, S. Ø., Drogset, J. O., Granviken, F., Rø, M., & Leivseth, G. (2017). Physical examination tests of the shoulder: A systematic review and meta-analysis of diagnostic test performance. BMC Musculoskeletal Disorders, 18, 41. https://doi.org/10.1186/s12891-017-1400-0
Zhang, A. L., et al. (2024). Evidence-based approach to the shoulder examination for subacromial bursitis and rotator cuff tears: A systematic review and meta-analysis. BMC Musculoskeletal Disorders, 25, Article 911.
The Scapular Assistance Test assesses whether manually assisting scapular upward rotation and posterior tilt changes shoulder pain, movement tolerance or perceived strength during arm elevation. It is best understood as a symptom-modification test rather than a stand-alone diagnostic test for scapular dyskinesis, impingement, rotator cuff pathology or shoulder injury.
A client reports shoulder pain when lifting the arm overhead, reaching forward, raising the arm in the scapular plane or completing sport or gym movements above shoulder height. The Scapular Assistance Test may reduce symptoms if manual assistance to the scapula improves the client’s movement tolerance during arm elevation.
The test should not be explained as “proving the scapula is the cause” or diagnosing scapular dyskinesis. A better interpretation is that it documents whether altering scapular motion changes the client’s familiar symptoms during elevation.
Test name: Scapular Assistance Test
Also known as: SAT, Modified Scapular Assistance Test
Body region: Shoulder, scapula, scapulothoracic movement
Purpose: Assess whether manual assistance to scapular motion changes pain or movement tolerance during arm elevation
Positive finding: Familiar shoulder symptoms reduce or movement tolerance improves with scapular assistance
Negative finding: No meaningful symptom or movement change with scapular assistance
Best used with: Scapular observation, shoulder ROM, Painful Arc, Hawkins-Kennedy Test, Neer’s Test, shoulder strength testing and functional overhead tasks
Key limitation: It is a symptom-modification test, not a stand-alone diagnostic test
The Scapular Assistance Test is a clinical symptom-modification test used during active shoulder elevation. The examiner manually assists scapular upward rotation and posterior tilt while the client lifts the arm.
The test is considered meaningful when assistance reduces familiar shoulder pain, improves the arc of movement or improves the client’s perceived ability to elevate the arm.
A positive test does not prove that scapular movement is the only cause of symptoms. It suggests that changing scapular mechanics may modify the client’s symptoms or movement tolerance.
The test is used when shoulder pain is provoked during arm elevation and the professional wants to determine whether manual assistance to scapular movement changes symptoms.
It may help guide assessment reasoning, exercise selection, cueing strategies and further testing of shoulder ROM, strength, load tolerance and functional movement.
The test assesses symptom response to assisted scapular movement during arm elevation.
It may provide information about whether scapular assistance changes:
Pain intensity
Painful arc
Ease of arm elevation
Perceived weakness
Movement confidence
Overhead tolerance
It does not diagnose scapular dyskinesis, rotator cuff pathology, subacromial pain, shoulder impingement or structural injury on its own.
This test may be useful for clients with shoulder pain during reaching, lifting, overhead activity, swimming, throwing, racquet sports, gym pressing, gym pulling or work tasks involving repeated arm elevation.
It may be particularly useful when symptoms appear during active movement rather than passive positioning alone.
Use when the client can actively elevate the arm and the clinical question involves whether scapular assistance changes symptoms or movement tolerance.
It is most useful when the client has a clear comparable movement, such as painful shoulder flexion, abduction or scaption, that can be repeated with and without scapular assistance.
Use caution with acute trauma, severe pain, recent surgery, instability, suspected fracture, high irritability, inability to lift the arm safely or inability to tolerate manual contact around the scapula.
Avoid overinterpreting the result in clients with non-specific pain, highly variable symptoms or symptoms that change simply because of repeated movement.
Open assessment space
Pain and symptom scale
Measurz recording workflow
Optional video
Optional comparison side notes
Position the client standing or sitting with enough space to lift the arm.
The client performs active shoulder elevation in the painful or relevant direction. This may be flexion, abduction or scaption depending on the client’s symptoms.
Ask the client to lift the arm without assistance first. Record pain location, pain intensity, painful arc, movement range, ease of movement and confidence.
Stand behind or slightly beside the client so you can guide scapular motion safely.
Place one hand around the superior or medial aspect of the scapula to assist upward rotation. The other hand may assist posterior tilt or guide the inferior angle depending on examiner preference and client anatomy.
Avoid forcing the shoulder or trunk. The goal is to assist scapular motion during active arm elevation, not to move the arm passively.
As the client elevates the arm, manually assist scapular upward rotation and posterior tilt.
Ask the client to repeat the same arm movement and report whether pain, range, ease of movement or weakness changes.
A positive finding is a meaningful reduction in familiar pain, improved movement tolerance or improved perceived strength during arm elevation with scapular assistance.
A negative finding is no meaningful change in familiar symptoms, range or movement tolerance with scapular assistance.
Stop if pain increases sharply, guarding occurs, the client cannot tolerate manual contact, symptoms become unacceptable or the assisted movement cannot be performed with control.
Do not force the scapula or arm. Record whether the test changed pain, range, ease of movement, strength perception or confidence.
A positive Scapular Assistance Test suggests that manually assisting scapular motion changes the client’s shoulder symptoms or movement tolerance.
This may support assessment reasoning around scapular contribution, movement modification, cueing, exercise selection or load management. It does not prove that scapular movement is the root cause of pain.
A negative test does not exclude scapular contribution or shoulder pathology. Symptoms may occur only under load, fatigue, speed, sport-specific movement or repeated activity.
The Scapular Assistance Test should not be treated as a traditional stand-alone diagnostic accuracy test for a single tissue or pathology.
It is better described as a symptom-modification test. Its purpose is to determine whether assisted scapular upward rotation and posterior tilt change symptoms during arm elevation.
Because the test does not diagnose one structure, sensitivity and specificity values are less clinically useful than the observed symptom response. The most relevant finding is whether the client’s familiar pain or movement limitation improves with assistance.
Reliability depends on consistent baseline movement, clear symptom criteria, examiner hand placement, assistance direction, movement plane and repeated comparison with the unassisted movement.
A systematic review of scapular assessment tools has cautioned that evidence is insufficient to strongly recommend any single instrument for assessing scapular posture, movement or dysfunction. This supports using the Scapular Assistance Test cautiously and interpreting it as part of a broader shoulder assessment rather than as a stand-alone measure.
Research on the Scapular Assistance Test has also investigated factors associated with positive and negative test results in people with shoulder pain during arm elevation. This supports the test’s role in understanding symptom modification, but not as a single diagnostic answer.
Common errors include treating the test as diagnostic, forcing the scapula, changing the arm movement between baseline and assisted trials, failing to record the baseline pain score, ignoring whether symptoms are familiar, using vague “better” or “worse” language and failing to record what changed.
Limitations include examiner handling variability, client symptom variability, repeated-movement effects, difficulty standardising manual assistance and limited ability to identify a specific tissue source.
The test may also be influenced by confidence, expectation, fatigue, pain irritability, movement speed and how strongly the examiner assists the scapula.
Use the Scapular Assistance Test to document whether assisted scapular motion changes symptoms during arm elevation.
It is most useful when combined with shoulder ROM, painful arc, Hawkins-Kennedy Test, Neer’s Test, shoulder strength testing, scapular observation and functional overhead tasks.
A positive result may help guide cueing, exercise selection, movement retraining, load modification or further assessment of scapular control and shoulder strength.
Record test name, side tested, baseline movement, assisted movement, result, pain score before and during assistance, symptom location, movement range, movement plane, perceived weakness, confidence, comparison side, compensation, examiner assistance direction and reason for stopping.
Useful notes include whether symptoms reduced, whether range improved, whether movement felt easier, whether pain location changed, whether the result was clearly positive or uncertain and whether repeated movement alone may have changed symptoms.
Add related findings such as scapular observation, Painful Arc, Hawkins-Kennedy Test, Neer’s Test, shoulder ROM, external rotation strength, abduction strength, flexion strength and overhead task symptoms.
Scapular Dyskinesis Observation
Painful Arc
Hawkins-Kennedy Test
Neer’s Test
Empty Can Test
Full Can Test
Shoulder ROM Tests
Shoulder Strength Testing
Shoulder External Rotation Strength
Overhead Reach Assessment
Wall Slide Assessment
It assesses whether manual assistance to scapular movement changes familiar shoulder pain or movement tolerance during arm elevation.
A positive finding is reduced familiar pain, improved movement tolerance or improved perceived strength when the examiner assists scapular upward rotation and posterior tilt.
No. It is better understood as a symptom-modification test rather than a diagnostic test for scapular dyskinesis.
No. It may modify symptoms associated with painful elevation, but it does not diagnose impingement or identify one tissue source.
No. Assistance should be controlled and comfortable. The test should stop if symptoms increase or the client cannot tolerate the movement.
Record side, baseline pain, assisted pain, symptom location, movement plane, range, whether movement improved and whether the symptoms were familiar.
The Scapular Assistance Test is a shoulder symptom-modification test.
It assesses whether assisting scapular motion changes pain or movement tolerance during arm elevation.
It does not diagnose scapular dyskinesis or identify one tissue source.
A positive result may guide movement modification, cueing and further assessment.
Use it with ROM, strength, painful arc, shoulder provocation tests and functional findings.
Measurz should capture baseline symptoms, assisted symptoms, movement plane, pain score, range change and test tolerance.
Kibler, W. B., Sciascia, A., & Wilkes, T. (2012). Scapular dyskinesis and its relation to shoulder injury. Journal of the American Academy of Orthopaedic Surgeons, 20(6), 364–372.
Moraes, G. F. S., et al. (2022). What factors contribute to the Scapular Assistance Test result? A classification and regression tree approach. PLOS ONE, 17(10), e0276662. https://doi.org/10.1371/journal.pone.0276662
Rabin, A., Irrgang, J. J., Fitzgerald, G. K., & Eubanks, A. (2006). The intertester reliability of the Scapular Assistance Test. Journal of Orthopaedic & Sports Physical Therapy, 36(9), 653–660. https://doi.org/10.2519/jospt.2006.2234
Timmons, M. K., Thigpen, C. A., Seitz, A. L., Karduna, A. R., Arnold, B. L., & Michener, L. A. (2012). Scapular kinematics and subacromial-impingement syndrome: A meta-analysis. Journal of Sport Rehabilitation, 21(4), 354–370.
van de Water, A. T. M., Ekegren, C. L., Treleaven, J., & Hardaker, N. (2020). Validity of clinical measurement instruments assessing scapular function: Insufficient evidence to recommend any instrument for assessing scapular posture, movement, and dysfunction—A systematic review. Journal of Orthopaedic & Sports Physical Therapy, 50(11), 632–641.
