Which history and physical findings are most useful in identifying rotator cuff tears?
Cross-body adduction test. The examiner adducts the arm across the patient’s body toward the opposite shoulder. Pain may indicate acromioclavicular joint pathology.1
Drop-arm sign. The examiner raises the patient’s arm to 160° and instructs the patient to lower the arm slowly to his or her side. If the patient has a rotator cuff tear, he or she won’t be able to control lowering the arm, and it will drop quickly to the side. The arm also may give way if the examiner taps it gently.1,2
Hawkins-Kennedy impingement sign. Patient flexes arm to 90° and bends elbow at 90°. The examiner stabilizes the shoulder with 1 hand and internally rotates it with the other hand. Pain on internal rotation may indicate subacromial impingement, including rotator cuff tendinopathy or tear.1,3
,Infraspinatus muscle strength test. Patient holds both arms at his or her sides with elbows flexed at 90° and actively rotates both arms externally against resistance by the examiner. Weakness on the affected side compared with the opposite side may signify infraspinatus or teres minor tendinopathy or tear.1
Neer impingement sign. With the patient’s arm fully pronated, the examiner stabilizes the scapula with 1 hand while performing maximal passive forward flexion and internal rotation with the other hand. Pain indicates subacromial impingement.4,5
Painful arc sign. The patient abducts the affected arm from his side to a fully raised position then slowly returns the arm to his side. Pain occurring between 60° and 120° of elevation may indicate inflammation of the tendons of the supraspinatus muscle.6,7
Speed’s test. While holding the affected arm with the elbow extended, forearm supinated, and humerus elevated to 60°, the patient flexes the shoulder forward 60°. The examiner resists the forward flexion while palpating the biceps tendon over the anterior aspect of the shoulder. Pain or tenderness in the bicipital groove indicates bicipital tendinitis.4,8
Supraspinatus muscle strength test (empty can test). With arms abducted to 90° and flexed forward 30° and thumbs turned downward, the patient actively resists downward pressure applied by the examiner. Weakness on the affected side compared with the opposite side may signify rotator cuff pathology, including supraspinatus tendinopathy or tear.1
References
1. Burbank KM, Stevenson JH, Czarnecki GR, et al. Chronic shoulder pain: part I. evaluation and diagnosis. Am Fam Physician. 2008;77:453-460.Available at: www.aafp.org/2008/0215/p453.html. Accessed January 2, 2010.
2. Moses S. Drop arm test. Family Practice Notebook 2009. Available at: www.fpnotebook.com/Ortho/Exam/DrpArmTst.htm. Accessed January 2, 2010.
3. Hawkins Kennedy test. UpToDate online 2009. Available at: www.uptodateonline.com/online/content/image.do?imageKey=/EM%2F3918. Accessed January 2, 2010.
4. Woodward TW, Best TM. The painful shoulder: part I. clinical evaluation. Am Fam Physician. 2000;61:3079-3088.Available at: www.aafp.org/afp/20000515/3079.html. Accessed January 2, 2010.
5. Gibson J. Neer impingement sign. Shoulderdoc 2005. Available at: www.shoulderdoc.co.uk/printarticle.asp?section=497&article=747. Accessed January 2, 2010.
6. Painful arc. Physiopedia. Available at: www.physio-pedia.com/index.php5?title=Painful_Arc. Accessed January 2, 2010.
7. Dorland’s Illustrated Medical Dictionary. 29th ed. Philadelphia: WB Saunders Company; 2000:1763.
8. Wheeless CR, III. Shoulder: physical exam. Wheeless’ Textbook of Orthopaedics. 2009. Available at: www.wheelessonline.com/ortho/shoulder_physical_exam. Accessed January 2, 2010.
