From the Guidelines
The most reliable physical exam tests for diagnosing rotator cuff tears are the Jobe test (empty can test), drop arm test, and external rotation lag sign, as they have been consistently shown to be sensitive and specific for detecting tears in the rotator cuff muscles. These tests are used to assess the integrity of the rotator cuff muscles, including the supraspinatus, infraspinatus, and teres minor. The Jobe test involves having the patient raise their arms to 90 degrees in the scapular plane with thumbs pointing downward, while the examiner applies downward pressure, and weakness or pain indicates a supraspinatus tear 1. The drop arm test is performed by passively abducting the patient's arm to 90 degrees and asking them to slowly lower it, and inability to do so smoothly suggests a tear. Other supportive tests include the Hawkins-Kennedy test and Neer impingement test, which can help identify impingement of the rotator cuff tendons, but are not as specific for diagnosing tears as the Jobe test and drop arm test 1. It's worth noting that while imaging studies such as MRI and ultrasonography can be useful adjuncts to physical examination for identifying rotator cuff tears, they are not necessary for diagnosis in all cases, and physical exam tests can be reliable for diagnosing tears, especially when used in combination 1. Some key points to consider when performing these tests include:
- The Jobe test is sensitive for supraspinatus tears, but may not be specific for other types of rotator cuff injuries.
- The drop arm test is sensitive for full-thickness rotator cuff tears, but may not be as sensitive for partial-thickness tears.
- The external rotation lag sign is sensitive for infraspinatus and teres minor tears, and can be used in combination with other tests to increase diagnostic accuracy.
From the Research
Physical Exam Tests for Rotator Cuff Tear
The following physical exam tests are used to diagnose rotator cuff tears:
- Drop arm sign: This test has a high specificity, but low sensitivity 2
- Jobe test: This test has the best pooled sensitivity, with a value of 0.77 (CI 0.67-0.85) 3
- External rotation lag sign: This test is one of the six tests eligible for meta-analysis in diagnosing posterosuperior rotator cuff tears 3
- Hawkins-Kennedy test: This test is also one of the six tests eligible for meta-analysis in diagnosing posterosuperior rotator cuff tears 3
- Neer test: This test is used to diagnose rotator cuff tears, but its accuracy is limited 3
- Painful arc abduction test: This test is used to diagnose rotator cuff tears, but its accuracy is limited 3
- Empty can test: This test has improved specificity after subacromial injection 2
Combination of Tests
No single clinical test is sufficiently reliable to diagnose posterosuperior rotator cuff tears, and clinicians should consider various combinations of patient characteristics and clinical tests, as well as imaging modalities, to confirm diagnosis and select the appropriate treatment option 3. Combining the empty can and drop arm tests can increase both sensitivity and specificity without injection 2.
Imaging Modalities
Ultrasound is a useful method to detect rotator cuff tears, with high sensitivity, specificity, and diagnostic accuracy 4. MRI is also used to evaluate acute, traumatic rotator cuff tears 5.