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Rotator cuff injury

Last reviewed: 20 Aug 2025
Last updated: 19 Sep 2025

Summary

Definition

History and exam

Key diagnostic factors

  • shoulder pain
  • shoulder weakness
  • loss of active range of motion
  • pain and weakness on external rotation test
  • pain and weakness on empty-can test
Full details

Other diagnostic factors

  • deltoid pain
  • night pain
  • pain and weakness on lift-off test
  • pain and weakness on belly-press test
  • pain on Neer impingement test
  • pain on Hawkins impingement test
  • adhesive capsulitis
Full details

Risk factors

  • age >60 years
  • history of repetitive overhead movement
  • history of superior labral tears
  • shoulder injury
Full details

Diagnostic tests

1st tests to order

  • x-rays
Full details

Tests to consider

  • diagnostic injection
  • MRI without contrast
  • ultrasound
  • magnetic resonance arthrography
  • CT arthrography
  • CT scan
Full details

Treatment algorithm

ACUTE

acute small tear

acute medium/large/massive reparable tear

acute irreparable tear

ONGOING

chronic symptomatic tear

Contributors

Authors

John D. Kelly IV, MD

Professor of Clinical Orthopaedic Surgery

Director of Sports Shoulder Service

Orthopaedic Surgery

University of Pennsylvania

Philadelphia

PA

Disclosures

JDK declares that he has no competing interests.

Acknowledgements

Dr John D. Kelly would like to gratefully acknowledge Dr Robert J. Gionfriddo, Dr Jason Jacob, Dr Daniel J. Solomon, and Dr Michael G. Clarke, previous contributors to this topic.

Disclosures

DJS serves as a speaker/course instructor for Arthrex Inc. and Pacific Medical Inc. and has received honoraria from both companies. RJG, JJ, and MGC declare that they have no competing interests.

Peer reviewers

Bassem Elhassan, MD

Professor of Orthopaedic Surgery

Harvard Medical School

Massachusetts General Hospital

Boston

MA

Disclosures

BE declares that he has received payment for consultancy from Antrex Incorporated and DJ Orthopaedics. He has also received royalties for intellectual property from DJ Orthopaedics.

Ryan Lohre, MD

Member of the Faculty

Harvard Medical School

Orthopaedic Shoulder Surgeon Massachusetts General Hospital

Boston

MA

Disclosures

RL declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Expert Panel on Musculoskeletal Imaging; Laur O, Ha AS, Bartolotta RJ, et al. ACR appropriateness criteria® acute shoulder pain: 2024 Update. J Am Coll Radiol. 2025 May;22(5S):S36-47.Full text  Abstract

Expert Panel on Musculoskeletal Imaging; Nicholas Nacey, Fox MG, Blankenbaker DG, et al. ACR appropriateness criteria® chronic shoulder pain: 2022 Update. J Am Coll Radiol. 2023 May;20(5S):S49-69. Abstract

Weber S, Chahal J. Management of rotator cuff injuries. J Am Acad Orthop Surg. 2020 Mar 1;28(5):e193-201.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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  • Patient information

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