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

Key Features

Essentials of Diagnosis

  • 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

General Considerations

  • Can be caused by

    • Acute injuries related to falls on an outstretched arm or to pulling on the shoulder

    • Chronic repetitive injuries with overhead movement and lifting

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

  • Full-thickness rotator cuff tears

    • Usually more symptomatic than partial tears

    • May require surgical treatment

  • The supraspinatus is the most commonly torn tendon

Clinical Findings

  • 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)

Table 41–1.Shoulder examination.

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