Test Item Cluster - Full-Thickness Rotator Cuff Tear

Purpose

To test the presence of a shoulder full-thickness rotator cuff tear using the Drop-Arm Sign, Painful Arc Sign, and the Infraspinatus Muscle Test.

Evidence

Based on the Park et al[1] study, the combination of the following 3 special tests have produced the highest post-test probability to diagnose a full-thickness rotator cuff tear:

  1. The Drop-Arm Sign
  2. The Painful Arc Sign
  3. Infraspinatus Muscle Test

The study concluded that if all 3 tests were positive, the probability of the patient having a full-thickness rotator cuff tear is 91%.[1]

Description and Illustrations

The Drop-Arm Sign

Patient actively elevates the arm in the scapular plane and then slowly reverses the motion.  A positive test is defined as the patient experiencing pain during the activity or that the arm suddenly drops.

The Painful Arc Sign (Fig 1)

Patient fully elevates the arm along the scapular plane and then slowly reverses the motion. If patient experiences pain between 60° and 120° of range of motion, the test is considered positive.


Image:Painful_arc.jpg

Figure 1 (couresty of http://www.maitrise-orthop.com)

Infraspinatus Muscle Test (Fig 2)

Arm is resting in neutral, the patient is instructed to flex elbow to 90° and resist against applied resistance mediall.  If the patient is unable to resist the force or experiences pain, the test is considered positive.

Image:Infraspinatus_test.jpg

Figure 2 (taken directly from Park et al[1])

References

  1. 1.0 1.1 1.2 Park HB, Yokota A, Gill HS, El RG, McFarland EG. Diagnostic accuracy of clinical tests for the different degrees of subacromial impingement syndrome. J Bone Joint Surg AmfckLR2005 July;87(7):1446-55.