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
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
- history of repetitive overhead movement
- history of superior labral tears
- shoulder injury
Diagnostic tests
1st tests to order
- x-rays
Tests 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
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
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
- Management of rotator cuff injuries
- ACR appropriateness criteria: shoulder pain - atraumatic
More GuidelinesPatient information
Rotator cuff injury
Shoulder injections
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