Shoulders
Clinical Examination for Rotator Cuff Tears
Introduction and Aim
Rotator cuff tears account for almost half of all major shoulder injuries. Despite this, the clinical assessment of rotator cuff tears can be difficult, even for the experienced clinician.
The purpose of this section is to describe how we determined which clinical tests can be used by physicians to easily and conveniently diagnose most rotator cuff tears in the clinic.
Methods
All patients were systematically examined with 23 commonly-used clinical shoulder tests, including tests for wasting (supraspinatus, infraspinatus deltoid), tenderness (S-C joint, A-C joint, sub acromial, and biceps), passive and active range of motion (forward flexion, abduction, interal rotation and external rotation), strength in internal and in external rotation, subscapular strength and supraspinatus strength, specific signs (drop arm sign, impingement in external rotation and in internal rotation, and O'Brien's sign). The arm positions for four of these tests are shown in the figure below.
The patients were then given an interscalene block and arthroscoped in order to identify their shoulder problem so they could be appropriately assigned to either of two groups:
Group 2
100 patients with shoulder pathology other than a rotator cuff tear (NRCT).
In order to confirm and validate the results of Study 1, we carried out a second study using a further 200 subjects which represented a more typical patient population.
Study 2
Group 1
100 patients with rotator cuff tear regardless of whether or not they had additional pathology (RCT).
Group 2
100 patients with shoulder pathology other than a rotator cuff tear (NRCT).
The clinical test results of the RCT and NRCT patient groups were compared and statistically analyzed.
Results
The prevalence of rotator cuff tear was shown to increase linearly with age.
Hence, because rotator cuff tears are strongly age-dependent, patient age must be taken into account when evaluating the probability of rotator cuff tear.
In both studies, SERI tests, i.e. the tests for (1)Supraspinatus weakness; (2) weakness in External Rotation; and Impingement, either in (3) internal rotation or (4) external rotation (as shown above), were found to be significant for predicting rotator cuff tear. These tests were much more likely to be positive in patients with rotator cuff tears than those without tears.
How SERI* Tests Can be Used in the Prediction of Rotator Cuff Tear
If a patient with a shoulder problem walks into a GP's office, the SERI tests can be performed and the table below checked to determine the patient's probability of a rotator cuff tear.
