What are the expected findings on exam for a patient with chronic left shoulder pain and full thickness, partial tears of supraspinatus and infraspinatus tendons?

Physical Examination Findings in Chronic Left Shoulder Pain with Full-Thickness Partial Tears of Supraspinatus and Infraspinatus

Expect focal weakness with decreased range of motion during abduction with external rotation, pain during overhead activities, and positive impingement signs on examination. 1

Primary Motor Findings

Weakness patterns:

• Focal weakness during shoulder abduction (supraspinatus involvement) with the arm positioned in external or internal rotation 1
• Loss of active external rotation strength when infraspinatus is involved, particularly when tested at the side with elbow flexed to 90 degrees 2
• Active elevation may be significantly decreased if the tear pattern is extensive 2

Range of motion deficits:

• Decreased passive shoulder abduction and external rotation of the glenohumeral joint are predictive findings in rotator cuff pathology 1
• Abduction is typically the range of motion most affected by shoulder pain in rotator cuff tears 3
• Possible restricted movement suggesting developing adhesive capsulitis may coexist 4

Pain Provocation Tests

Impingement signs:

• Positive Neer impingement sign (shoulder pain with passive abduction of the internally rotated arm) is a key finding 1
• Pain located in the anterior or anterolateral aspect of the shoulder during overhead activities 1
• Tenderness to palpation over the supraspinatus tendon in the subacromial region 1

Specific tendon testing:

• Pain and weakness with resisted external rotation testing (infraspinatus involvement) 1
• Maneuvers isolating supraspinatus and infraspinatus will reproduce pain and demonstrate weakness 3

Important Clinical Caveats

Physical examination limitations:

• Physical examination has low sensitivity and specificity for detecting rotator cuff tears, particularly in patients with inflammatory conditions 3
• The presence of motor weakness is more predictive than the severity of pain for underlying structural pathology 1
• Motor impairment may be the more important predictive factor than shoulder subluxation alone 1

Associated findings to assess:

• Evaluate for shoulder subluxation, which is associated with pain development but has strong covariance with motor weakness 1
• Assess scapular positioning and movement patterns, as scapular dyskinesis contributes to rotator cuff injury 1
• Check for tenderness over the biceps tendon, which may coexist with rotator cuff pathology 1