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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 with full-thickness rotator cuff tears there may be more obvious weakness noted with light resistance testing of specific rotator cuff muscles

  • Shoulder examination

    • Supraspinatus tendon strength ("open can" test)

    • Infraspinatus/teres minor strength

    • Subscapularis strength

    • Neer and Hawkins impingement tests are usually positive (Table 41–1)

Table 41–1.Shoulder examination.

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