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Review
. 2013 Jan;5(1):45-56.
doi: 10.1016/j.pmrj.2012.08.019.

Clinical examination of the rotator cuff

Nitin B Jain  1 , Reg B Wilcox 3rd, Jeffrey N Katz, Laurence D Higgins
Affiliations
Review

Clinical examination of the rotator cuff

Nitin B Jain et al. PM R. 2013 Jan.

Abstract

Rotator cuff tears are the leading cause of shoulder pain and shoulder-related disability and account for 4.5 million physician visits in the United States annually. A careful history and structured physical examination are often sufficient for diagnosing rotator cuff disorders. We are not aware of a clinical review article that presents a structured physical examination protocol of the rotator cuff for the interested clinician. To fill this void, we present a physical examination protocol developed on the basis of review of prior literature and our clinical experience from dedicated shoulder practices. Our protocol includes range of motion testing by using a goniometer, strength testing by using a dynamometer, and select special tests. Among the many tests for rotator cuff disorders that have been described, we chose ones that have been more thoroughly assessed for sensitivity and specificity. This protocol can be used to isolate the specific rotator cuff tendon involved. The protocol can typically be completed in 15 minutes. We also discuss the clinical implications and limitations of the physical examination maneuvers described in our protocol. This protocol is thorough yet time efficient for a busy clinical practice. It is useful in the diagnosis of rotator cuff tears, impingement syndrome, and biceps pathology.

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Figures

Figure 1
Figure 1. Anatomy of the anterior rotator cuff (reproduced and modified with permission from Primal Pictures Limited)
a=Supraspinatus tendon; b=Subscapularis tendon; c=Long head of biceps brachii tendon; d=Long head of biceps brachii tendon sheath; e=Greater tuberosity of the humerus; f=Acromion; g=Coracoid; h=Supraspinatus muscle; i=Subscapularis muscle
Figure 2
Figure 2. Anatomy of the posterior rotator cuff (reproduced and modified with permission from Primal Pictures Limited)
a=Supraspinatus tendon; b=Infraspinatus tendon; c=Teres Minor tendon; d=Greater tuberosity; e=Acromion; f=Infraspinatus muscle; g=Teres Minor muscle
Figure 3
Figure 3. Range of motion testing
a. Forward flexion b. Isolated abduction c. External rotation in neutral d. External rotation in abduction
Figure 3
Figure 3. Range of motion testing
a. Forward flexion b. Isolated abduction c. External rotation in neutral d. External rotation in abduction
Figure 3
Figure 3. Range of motion testing
a. Forward flexion b. Isolated abduction c. External rotation in neutral d. External rotation in abduction
Figure 3
Figure 3. Range of motion testing
a. Forward flexion b. Isolated abduction c. External rotation in neutral d. External rotation in abduction
Figure 4
Figure 4. Strength testing using a dynamometer
a. External rotation b. Abduction c. Internal rotation
Figure 4
Figure 4. Strength testing using a dynamometer
a. External rotation b. Abduction c. Internal rotation
Figure 4
Figure 4. Strength testing using a dynamometer
a. External rotation b. Abduction c. Internal rotation
Figure 5
Figure 5. Special tests for subscapularis
a. Lift-off test b. Belly-press test c. Belly-off sign d. Bear hug test
Figure 5
Figure 5. Special tests for subscapularis
a. Lift-off test b. Belly-press test c. Belly-off sign d. Bear hug test
Figure 5
Figure 5. Special tests for subscapularis
a. Lift-off test b. Belly-press test c. Belly-off sign d. Bear hug test
Figure 5
Figure 5. Special tests for subscapularis
a. Lift-off test b. Belly-press test c. Belly-off sign d. Bear hug test
Figure 6
Figure 6. Special tests for supraspinatus and infraspinatus
a. External rotation lag sign in neutral b. External rotation lag sign in abduction c. Jobe’s test
Figure 6
Figure 6. Special tests for supraspinatus and infraspinatus
a. External rotation lag sign in neutral b. External rotation lag sign in abduction c. Jobe’s test
Figure 6
Figure 6. Special tests for supraspinatus and infraspinatus
a. External rotation lag sign in neutral b. External rotation lag sign in abduction c. Jobe’s test
Figure 7
Figure 7. Hornblower’s Sign
Figure 8
Figure 8. Speed’s test
Figure 9
Figure 9. Neer’s sign
See this image and copyright information in PMC

Comment in

References

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