What are the expected findings on palpation charting for a patient with an incomplete tear of the right rotator cuff?

Palpation Findings for Incomplete Right Rotator Cuff Tear

Palpation charting for a patient with an incomplete tear of the right rotator cuff would reveal localized tenderness over the affected tendon, most commonly the supraspinatus, with associated muscle guarding and possible subacromial crepitus.

Key Palpation Findings

Tenderness and Pain

• Specific tender points:
  • Anterolateral aspect of the shoulder (supraspinatus insertion at the greater tuberosity)
  • Subacromial space tenderness
  • Bicipital groove (if biceps tendon involvement)
  • Posterior aspect of the shoulder (if infraspinatus involvement)
• Pain typically increases with direct pressure over the affected tendon 1

Muscle Tone Abnormalities

• Increased muscle tone/guarding in the trapezius and levator scapulae (compensatory)
• Possible atrophy of the supraspinatus or infraspinatus muscles in chronic cases
• Muscle spasm in surrounding musculature 2

Tissue Texture Changes

• Edema and swelling in the acute phase
• Thickening of the subacromial bursa
• Possible crepitus with passive movement during palpation 1

Temperature and Skin Changes

• Mild localized warmth over the affected area in acute cases
• No significant skin changes typically noted

Palpation Technique

1. Patient positioning: Seated with arm relaxed at side

2. Systematic approach:

   • Begin with general shoulder girdle palpation
   • Progress to specific rotator cuff insertion points
   • Compare findings with unaffected left shoulder

3. Key areas to palpate:

   • Greater tuberosity of humerus (supraspinatus insertion)
   • Lesser tuberosity (subscapularis insertion)
   • Posterior humeral head (infraspinatus and teres minor)
   • Bicipital groove
   • Acromioclavicular joint
   • Subacromial space 1

Associated Physical Examination Findings

While not strictly palpation findings, these should be noted alongside palpation charting:

• Pain with specific movements (especially abduction)
• Weakness with resisted movement of the affected tendon
• Positive special tests:
  • Painful arc (70-120° abduction)
  • Positive impingement signs (Neer, Hawkins-Kennedy)
  • Weakness in external rotation (infraspinatus involvement)
  • Weakness in abduction (supraspinatus involvement) 1

Documentation Considerations

• Document precise location of maximum tenderness using anatomical landmarks
• Note any differences in tissue texture compared to contralateral side
• Record patient's pain response using numerical scale (0-10)
• Document any associated muscle guarding or spasm
• Note any crepitus felt during passive movement while palpating 2

Clinical Pearls and Pitfalls

• Pearl: Incomplete tears most commonly affect the articular surface of the supraspinatus tendon, making anterolateral tenderness a key finding 1
• Pearl: Compare with contralateral side to identify subtle differences in tissue texture and tenderness
• Pitfall: Tenderness at the acromioclavicular joint may indicate concomitant AC joint pathology rather than rotator cuff tear
• Pitfall: Absence of palpable defect does not rule out partial tear, as these are not typically palpable through intact layers 1

Remember that palpation findings alone are insufficient for diagnosis, and imaging studies (particularly MRI without contrast) are usually appropriate (rated 7/9) for confirming incomplete rotator cuff tears when radiographs are noncontributory 1, 2.