Summary
Definition
History and exam
Key diagnostic factors
- shoulder pain
- shoulder weakness
- loss of active ROM
- pain and weakness on external rotation test
- pain and weakness on empty-can test
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
Risk factors
- age >60 years
- hx of repetitive overhead movement
- hx of superior labral tears
- shoulder injury
Diagnostic investigations
1st investigations to order
- x-rays
Investigations to consider
- diagnostic injection
- MRI
- ultrasound
- magnetic resonance arthrography
- CT arthrography
- CT scan
Treatment algorithm
acute small tear
acute medium/large/massive reparable tear
acute irreparable tear
chronic symptomatic tear
Contributors
Authors
Robert J. Gionfriddo, DO
Assistant Director
Department of Medicine
Hartford Hospital
Hartford
CT
Disclosures
RJG declares that he has no competing interests.
Jason Jacob, MD
Assistant Director
Department of Medicine
Hartford Hospital
Hartford
CT
Disclosures
JJ declares that he has no competing interests.
Acknowledgements
Dr Robert J. Gionfriddo and Dr Jason Jacob would like to gratefully acknowledge Dr Daniel J. Solomon and Dr Michael G. Clarke, previous contributors to this monograph. DJS serves as a speaker/course instructor for Arthrex Inc. and Pacific Medical Inc. and has received honoraria from both companies. MGC declares that he has no competing interests.
Peer reviewers
Matthew T. Provencher, MD
Assistant Director
Orthopaedic Shoulder and Sports Surgery
Naval Medical Center San Diego
San Diego
CA
Disclosures
MTP declares that he has no competing interests.
Radhakant Pandey, FRCS, McH(orth)
Consultant in Trauma and Orthopaedics
Department of Trauma and Orthopaedics
Leicester Royal Infirmary
Leicester
UK
Disclosures
RP declares that he has no competing interests.
Differentials
- Rotator cuff impingement
- Rotator cuff tendonitis
- Subacromial bursitis
More DifferentialsGuidelines
- Optimizing the management of rotator cuff problems
- Optimizing the management of rotator cuff problems
More GuidelinesPatient leaflets
Rotator cuff injury
Shoulder injections
More Patient leafletsLog in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer