Rotator Cuff Tears

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)