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Rotator cuff injury

Last reviewed: 4 Oct 2024
Last updated: 15 Dec 2023

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
  • 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

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.

  • Rotator cuff injury images
  • Differentials

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  • Guidelines

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    • ​ACR appropriateness criteria: shoulder pain - atraumatic
    More Guidelines
  • Patient information

    Rotator cuff injury

    Shoulder injections

    More Patient information
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