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Rotator cuff injury

Last reviewed: 4 Sep 2023
Last updated: 07 Feb 2023



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
More key diagnostic factors

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
Other diagnostic factors

Risk factors

  • age >60 years
  • history of repetitive overhead movement
  • history of superior labral tears
  • shoulder injury
More risk factors

Diagnostic investigations

1st investigations to order

  • x-rays
More 1st investigations to order

Investigations to consider

  • diagnostic injection
  • MRI
  • ultrasound
  • magnetic resonance arthrography
  • CT arthrography
  • CT scan
More investigations to consider

Treatment algorithm


acute small tear

acute medium/large/massive reparable tear

acute irreparable tear


chronic symptomatic tear



John D. Kelly IV, MD

Professor of Clinical Orthopaedic Surgery

Director of Sports Shoulder Service

Orthopaedic Surgery

University of Pennsylvania




JDK declares that he has no competing interests.


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.


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

Matthew T. Provencher, MD

Assistant Director

Orthopaedic Shoulder and Sports Surgery

Naval Medical Center San Diego

San Diego



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




RP declares that he has no competing interests.

  • Rotator cuff injury images
  • Differentials

    • Rotator cuff impingement
    • Rotator cuff tendonitis
    • Subacromial bursitis
    More Differentials
  • Guidelines

    • ​Management of rotator cuff injuries
    • ​ACR appropriateness criteria: shoulder pain - atraumatic
    More Guidelines
  • Patient leaflets

    Rotator cuff injury

    Shoulder injections

    More Patient leaflets
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