title: The champagne toast position isolates the supraspinatus better than the Jobe test: an electromyographic study of shoulder physical examination tests.
abstract: BACKGROUND
  While Jobe's test is widely used, it does not isolate supraspinatus activity. Our purpose was to examine the electromyographic (EMG) activity within the supraspinatus and deltoid with resisted abduction to determine the shoulder position that best isolates the activity of the supraspinatus.
  
  
  METHODS
  We performed EMG analysis of the supraspinatus, anterior head of the deltoid, and middle head of the deltoid in 10 normal volunteers. We measured EMG activity during resisted shoulder abduction in the scapular plane to both manual resistance and a standardized load in varying degrees of abduction and rotation. To determine which position best isolates supraspinatus activity, the ratio of supraspinatus to deltoid activity (S:D) was calculated for each position. Results were analyzed with a repeated-measures analysis of variance with Bonferroni correction. The posterior deltoid was excluded as it serves mostly to extend and externally rotate.
  
  
  RESULTS
  Our study confirmed Jobe's findings of maximal supraspinatus activity at 90° of abduction. However, decreasing abduction significantly increased S:D for both resisted manual testing and testing against a standardized load (P = .002 and .001, respectively). The greatest S:D ratio (4.6 ± 3.4 for standardized load testing) was seen at the "champagne toast" position, i.e., 30° of abduction, mild external rotation, 30° of flexion, and 90° of elbow flexion. The smallest ratio (0.8 ± 0.6) was seen at Jobe's position.
  
  
  CONCLUSIONS
  Testing of abduction strength in the champagne toast position, i.e., 30° of abduction, mild external rotation, and 30° of flexion, better isolates the activity of the supraspinatus from the deltoid than Jobe's "empty can" position.
authors.affiliation: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA. Electronic address: p.n.chalmers@gmail.com.
authors.forename: Peter N
authors.initials: PN
authors.lastname: Chalmers
authors.affiliation: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Cvetanovich
authors.affiliation: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.
authors.forename: Noam
authors.initials: N
authors.lastname: Kupfer
authors.affiliation: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.
authors.forename: Markus A
authors.initials: MA
authors.lastname: Wimmer
authors.affiliation: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.
authors.forename: Nikhil N
authors.initials: NN
authors.lastname: Verma
authors.affiliation: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Cole
authors.affiliation: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.
authors.forename: Anthony A
authors.initials: AA
authors.lastname: Romeo
authors.affiliation: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.
authors.forename: Gregory P
authors.initials: GP
authors.lastname: Nicholson
mesh_terms: D000328:Adult; D057645:Deltoid Muscle / Q000502:physiology*; D004576:Electromyography; D005260:Female; D064368:Healthy Volunteers; D006801:Humans; D008488:Medical Illustration; D053580:Muscle Strength; D056888:Patient Positioning; D010781:Photography; D010808:Physical Examination / Q000379:methods*; D012399:Rotation; D017006:Rotator Cuff / Q000502:physiology*; D012782:Shoulder / Q000502:physiology*; D055815:Young Adult
keywords: Rotator cuff; deltoid; electromyography; shoulder physical examination; supraspinatus