Which history and physical findings are most useful in identifying rotator cuff tears?
IT’S UNKNOWN WHICH—IF ANY—HISTORICAL FACTORS ARE MOST USEFUL, because no studies evaluating their accuracy with rotator cuff tears have been done. As for physical findings, no single physical examination finding is sensitive or specific enough to detect partial-thickness rotator cuff tears (strength of recommendation [SOR]: B, systematic review of lower-quality cohort studies).
The combination of the painful arc sign, drop-arm sign, and infraspinatus muscle strength test are helpful in detecting a full-thickness rotator cuff tear (SOR: B, a single prospective study).
A negative supraspinatus muscle strength test alone is sensitive enough to decrease the likelihood of a significant rotator cuff tear (SOR: B, a single prospective study).
,Evidence summary
The largest meta-analysis to look at the effectiveness of clinical examination and patient history for diagnosing soft-tissue shoulder disorders evaluated 10 cohort studies.1 Pooled results from 4 of the studies suggested that a composite clinical examination could safely rule out a full-thickness rotator cuff tear with a sensitivity of 0.9 (95% confidence interval [CI], 0.87-0.93). The standard in the studies cited was either arthrography or surgery. No single physical examination finding, when looked at in isolation, could reliably produce comparable accuracy.
The best 3 tests for full-thickness rotator cuff tear
A retrospective cohort study stratified 352 patients who had undergone operative evaluation by the degree of severity of rotator cuff pathology.2 Investigators assessed 8 physical exam tests—the Neer impingement sign, Hawkins-Kennedy impingement sign, painful arc sign, supraspinatus muscle strength test, Speed’s test, cross-body adduction test, drop-arm sign, and infraspinatus muscle strength test—to determine their diagnostic utility. (See “A glossary of tests for rotator cuff injury”)
