From the Guidelines
The most effective clinical tests for diagnosing rotator cuff injuries are the Empty Can Test, Drop Arm Test, and External Rotation Lag Sign, which should be used in combination with imaging studies like ultrasound or MRI to confirm the diagnosis and determine the extent of injury. Several clinical tests can help diagnose rotator cuff injuries, including:
- Empty Can Test (Jobe Test): have the patient raise their arms to 90 degrees in the scapular plane with thumbs pointing downward, then resist downward pressure; pain or weakness indicates supraspinatus pathology.
- Drop Arm Test: passively abduct the patient's arm to 90 degrees and ask them to lower it slowly; inability to do so suggests a rotator cuff tear.
- External Rotation Lag Sign: involves supporting the patient's elbow at 90 degrees flexion with the shoulder in neutral position, then passively rotating the arm externally and asking the patient to hold this position; inability to maintain the position indicates infraspinatus or teres minor involvement. Other useful tests include the Hawkins-Kennedy Test for impingement and the Lift-Off Test for subscapularis tears. According to a study published in The Journal of the American Academy of Orthopaedic Surgeons 1, strong evidence supports that magnetic resonance imaging, magnetic resonance angiography, and ultrasonography are useful adjuncts to a clinical examination for identifying rotator cuff tears.
When positive findings occur, imaging studies like ultrasound or MRI should follow to confirm the diagnosis and determine the extent of injury, as recommended by the American College of Radiology 1. These tests are most effective when used in combination rather than isolation, as this improves diagnostic accuracy.
In terms of imaging, a study published in the Journal of the American College of Radiology 1 suggests that MRI is currently the procedure of choice for the evaluation of occult fractures and the shoulder soft tissues, including the tendons, ligaments, muscles, and labrocapular structures. Ultrasound with appropriate local expertise is also excellent in the depiction of rotator cuff and long head of biceps pathology in the preoperative and postoperative shoulder.
Overall, a combination of clinical tests and imaging studies is the most effective approach for diagnosing rotator cuff injuries, as it allows for accurate diagnosis and determination of the extent of injury, which is essential for guiding treatment and improving patient outcomes.
From the Research
Clinical Tests for Rotator Cuff Injury
- The diagnosis of rotator cuff disorders can be made through a careful history and structured physical examination, which can include range of motion testing, strength testing, and special tests 2.
- A physical examination protocol for the rotator cuff can be used to isolate the specific tendon involved and can typically be completed in 15 minutes 2.
- Clinical tests such as supraspinatus weakness, weakness of external rotation, and impingement can be highly predictive of rotator cuff tear, especially in patients older than 60 years 3.
- Magnetic resonance imaging (MRI) or ultrasound can confirm a possible full-thickness tear, while conventional arthrography can be used as an alternative for patients with implantable devices prohibiting MRI imaging 3.
- The diagnostic validity of physical examination maneuvers for rotator cuff lesions has been investigated, and it was found that no single test is sufficient to diagnose rotator cuff damage, but a combination of tests can improve the ability to diagnose damage to the rotator cuff 4.
- The sensitivity, specificity, and likelihood ratios of various clinical tests for rotator cuff pathology have been reported, and it was found that most tests are inaccurate, and there is insufficient evidence to recommend one clinical test over another for diagnosis of rotator cuff pathology 5.
- A systematic review and meta-analysis of clinical tests for subacromial impingement syndrome found that certain tests, such as the Hawkins-Kennedy test, Neer's sign, and empty can test, are more useful for ruling out rather than ruling in the syndrome, while others, such as the drop arm test and lift-off test, are more useful for ruling in the syndrome if the test is positive 6.