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Rotator Cuff Tears

For further information, see CMDT Part 41-02: Musculoskeletal Injuries of the Shoulder

Key Features

  • Can be due to trauma or be more degenerative

  • Can be caused by acute injuries related to falls on an outstretched arm or to pulling on the shoulder

  • Can also be related to chronic repetitive injuries with overhead movement and lifting

  • Partial tears are one of the most common reasons for impingement syndrome

  • Full thickness rotator cuff tears are usually more symptomatic and may require surgical treatment

  • The most commonly torn tendon is the supraspinatus

Clinical Findings

  • Difficulty lifting the arm with limited active range of motion

  • Weakness with resisted strength testing suggests full thickness tears

  • Night pain is also a common complaint

  • The affected patient usually also has positive Neer and Hawkins impingement tests usually positive

  • See Table 41–1

Table 41–1.Shoulder examination.
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Table 41–1. Shoulder examination.

Maneuver

Description

Inspection

Check the patient’s posture and “SEADS” (swelling, erythema, atrophy, deformity, surgical scars).

Palpation

Include important landmarks: acromioclavicular (AC) joint, long head of biceps tendon, coracoid, and greater tuberosity (supraspinatus insertion).

Range of motion testing

Check range of motion actively (patient performs) and passively (clinician performs).

Flexion

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Move the arm forward as high as possible in the sagittal plane.

External rotation

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Check with the patient’s elbow touching their body so that external rotation occurs predominantly at the glenohumeral joint.

Internal rotation

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The patient is asked to reach the thumbs as high as possible behind the spine on each side. The clinician can record the highest spinous process that the individual can reach on each side (iliac crest = L4, inferior angle of scapula = T8).

Rotator Cuff Strength Testing

Supraspinatus (open can) test

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Perform resisted shoulder abduction at 90 degrees with slight forward flexion to around 45 degrees to test for supraspinatus tendon strength (“open can” test), or with shoulder abduction at 30 degrees and flexion to 30 degrees (“empty can” test).

External rotation

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The patient resists by externally rotating the arms with elbows at his or her side.

Internal rotation (lift-off test)

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A positive “lift-off” test is the inability of the patient to hold his or her hand away from the body when reaching toward the small of the back. The clinician pushes the patient’s hand toward the back while the patient resists. A positive lift-off indicates subscapularis tendon insufficiency.

Internal rotation (belly-press test)

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A positive “belly-press” test is the inability to hold the elbow in front of the trunk while pressing down with the hand on the belly. A positive belly-press test indicates subscapularis tendon insufficiency.

Impingement Testing

Neer impingement sign

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Perform by having the clinician flex the shoulder maximally in an overhead position. The test is positive when pain is reproduced with full passive shoulder flexion. Sensitivity is 79%; specificity is 53%.

Hawkins impingement sign...

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