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Essentials of Diagnosis
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A common cause of shoulder impingement syndrome after age 40
Difficulty lifting the arm with limited active range of motion
Weakness with resisted strength testing suggests full-thickness tears
Tears can occur following trauma or can be more degenerative
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General Considerations
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Can be caused by
Partial rotator cuff tears are one of the most common reasons for impingement syndrome
Full-thickness rotator cuff tears
The supraspinatus is the most commonly torn tendon
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Weakness or pain with overhead movement
Night pain is also a common complaint
The clinical findings with rotator cuff tears include those of the impingement syndrome, except that there may be more obvious weakness noted with light resistance testing of specific rotator cuff muscles with full-thickness rotator cuff tears
Supraspinatus tendon strength is tested with resisted shoulder abduction at 90 degrees with slight forward flexion to around 45 degrees ("open can" test)
Infraspinatus/teres minor strength is tested with resisted shoulder external rotation with shoulder at 0 degrees of abduction and elbow by side
Subscapularis strength is tested with the "lift-off" or "belly-press" tests
Neer and Hawkins impingement tests are usually positive (Table 41–1)
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