From the Guidelines
The most reliable test for diagnosing a rotator cuff tear is ultrasonography (US), as it can accurately evaluate the rotator cuff tendons and is not hindered by prosthesis-related artifact in patients with shoulder arthroplasty. According to the study by 1, US is a reliable option to evaluate rotator cuff tears in the setting of a shoulder arthroplasty, and can diagnose tears of the supraspinatus, infraspinatus, and subscapularis tendons.
Key Points
- Ultrasonography (US) is a reliable test for diagnosing rotator cuff tears, especially in patients with shoulder arthroplasty 1.
- US can accurately evaluate the rotator cuff tendons and is not affected by prosthesis-related artifact.
- Other imaging modalities, such as magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA), can also be useful in diagnosing rotator cuff tears, but may be limited by prosthesis-related artifact in patients with shoulder arthroplasty.
- Clinical examination tests, such as the Jobe test, drop arm test, and external rotation lag sign, can also be useful in diagnosing rotator cuff tears, but may be less specific than imaging modalities.
Imaging Modalities
- Ultrasonography (US): reliable test for diagnosing rotator cuff tears, especially in patients with shoulder arthroplasty 1.
- Magnetic Resonance Imaging (MRI): useful in diagnosing rotator cuff tears, but may be limited by prosthesis-related artifact in patients with shoulder arthroplasty.
- Magnetic Resonance Angiography (MRA): useful in diagnosing rotator cuff tears, but may be limited by prosthesis-related artifact in patients with shoulder arthroplasty.
Clinical Examination Tests
- Jobe test: tests for supraspinatus tears by having the patient raise their arms to 90 degrees in the scapular plane with thumbs pointing downward.
- Drop arm test: tests for rotator cuff tears by passively abducting the patient's arm to 90 degrees and asking them to lower it slowly.
- External rotation lag sign: tests for infraspinatus tears by having the examiner hold the patient's elbow at 90 degrees flexion and shoulder in 20 degrees elevation, then releasing the wrist while maintaining elbow position.
From the Research
Tests for Rotator Cuff Tears
- The following tests are used to diagnose rotator cuff tears:
- Jobe's test for supraspinatus tears 2
- Patte's test for infraspinatus tears 2
- Lift-off test for subscapularis tears 2
- Palm-up test for long head of the biceps brachii 2
- Internal rotation and lateral rotation lag sign, although their use is not recommended for diagnosing supraspinatus and subscapularis tears 3
- These tests have varying degrees of sensitivity and specificity, with none being highly sensitive for diagnosing rotator cuff tears or tendinosis 3
- A combination of tests may improve the ability to diagnose damage to the rotator cuff 3
Diagnostic Value of Tests
- The diagnostic value of these tests is limited by their poor specificity, particularly for determining the location and type of rotator cuff lesions 2
- The severity of functional impairment during Jobe's and Patte's maneuvers is not correlated with the size of the tear 2
- Ultrasound imaging can be used to diagnose rotator cuff tears, but its accuracy is highly user dependent and requires significant training and practice 4
Clinical Implications
- A careful history and structured physical examination are often sufficient for diagnosing rotator cuff disorders 5
- Physical examination maneuvers can be used to isolate the specific rotator cuff tendon involved and to diagnose rotator cuff tears, impingement syndrome, and biceps pathology 5
- Conservative treatment may be effective for patients with rotator cuff tears, particularly those with well-preserved function of the supraspinatus and infraspinatus 6