During a physical exam for a
rotator cuff disorder, your doctor will
look at your shoulder for signs of swelling, discoloration, muscle
deterioration (atrophy), deformities, or abnormal appearance. He or she also
will press around your shoulder and arm to check for any tenderness, swelling,
Your doctor will examine your range of motion,
stability, strength, blood flow, reflexes, and sensation in both the injured
and uninjured arms. Moving the arms in specific ways can provide information
about the condition of the rotator cuff tendons and the shoulder joint.
Your doctor may conduct tests to find out whether
you have subacromial
impingement or a tear in the rotator cuff.
Tests for subacromial impingement
Tests for rubbing of the tendon on the bone (impingement) are
based on whether certain movements cause pain and discomfort. To test for
impingement, your doctor may have you:
Raise your arm straight out in front to
shoulder height (forward flexion).
Raise your arm out to your side
Do either step 1 or step 2 and ask you to rotate your
arm or rotate your arm for you.
Do either step 1 or step 2 and
apply resistance to your arm.
Your doctor will consider how painful these
movements are to you and, if there was pain, what position your shoulder was
Another test involves injecting a pain reliever (such as
lidocaine) into the
bursa and near the rotator cuff tendons of your
shoulder (subacromial space injection). If this relieves your pain, then you
probably have rotator cuff abrasion or subacromial
bursitis. Your doctor may then inject
corticosteroids into the area to reduce inflammation.
But if your shoulder is still weak after the injection of anesthetic, the
problem may be a rotator cuff tear.
Tests for a rotator cuff tear
The main symptoms of a complete rotator cuff tear are pain and
weakness. Tests for rotator cuff tears include the following:
Drop arm test: Hold your arm straight out to
your side (90 degrees) with your thumb down. Lower your arm slowly. If it drops
suddenly, you probably have a rotator cuff tear.
Hold your arm
straight out to the side, level with your shoulder, with your palm facing down
(hand in a fist). Your doctor will press your arm down to
determine your strength in this position.
Raise your arm straight
in front about shoulder height (90 degrees) and turn your wrist so your thumb
points toward the floor. Your doctor will try to push your arm down
against your resistance. If your rotator cuff is weak or torn, you will not be
able to hold your arm steady as your doctor pushes down on
Raise your arm straight in front about shoulder height (90
degrees) and turn your palm up toward the ceiling. Your doctor
will try to force your hand downward against your resistance. If your rotator
cuff is weak or torn, you will not be able to hold your arm steady as your
doctor pushes down on it. If you have more pain or weakness in
this position, you may also have biceps tendon damage.
arm at your side, bend your elbow, and turn your wrist so your thumb points
toward the ceiling. Your doctor will try to force your hand in
toward your stomach as you resist by trying to rotate your arm outward. If your
rotator cuff is weak or torn, you will not be able to hold your arm steady as
your doctor pushes on it.
The touchdown test: Raise your arms alongside your ears, with
your palms facing inward. Your doctor will stand behind you and push your arms
forward. If you have trouble resisting this, you may have a rotator cuff
The specific movements that cause pain or weakness are clues to
the location of a rotator cuff tear.
Why It Is Done
A physical exam is always done for shoulder pain.
If your doctor thinks your shoulder may be broken or
X-rays may be done before a physical
In rotator cuff
tendinitis, tests usually cause some pain or
If tests are nearly normal (negative), you
may have mild tendinitis or bursitis.
Nonsurgical treatment may be
started even if the tests are just slightly positive.
If an injection
of anesthetic into your shoulder relieves pain during the impingement tests,
you are more likely to have a rotator cuff problem.
For a torn rotator cuff, weakness with or without pain is the key
If you have a complete tear, you may be unable
to raise your arm straight to the side or to hold your arm in that position if
your doctor moves it there.
Rupture of the long head
of the biceps tendon, which is often minimally painful, may be apparent as the
muscle rolls into a ball down near the elbow. This also can be a marker for a
rotator cuff tear.
If you have a torn rotator cuff, many tests may
be abnormal (positive).
Injecting an anesthetic into your shoulder
may relieve pain but will not restore strength if you have a torn rotator
It may be hard to tell the difference between partial tears
of the rotator cuff and rotator cuff tendinitis or bursitis.
You may have a rotator cuff tear but still have normal shoulder
motion and strength. In these cases, the tear is usually mild.
What To Think About
More extensive and costly diagnostic studies can help determine the
cause of shoulder pain or weakness. Your medical history and overall health
status, symptoms, age, and occupation or activity level are things your doctor will think about when recommending whether you should have any of
For example, a professional athlete or a person who hangs wallpaper
for a living may warrant more tests earlier than a relatively inactive older
adult. A more complete diagnosis is important if you need a strong shoulder or
if you may continue activities that will further damage your shoulder.
Lin KC, et al. (2010). Rotator cuff: 1. Impingement lesions in adult and adolescent athletes. In JC DeLee et al.,
eds., DeLee and Drez's Orthopaedic Sports Medicine, Principles and Practice, 3rd ed., vol. 1, pp. 986–1015. Philadelphia: Saunders Elsevier.
Primary Medical Reviewer
William H. Blahd, Jr., MD, FACEP - Emergency Medicine
How this information was developed to help you make better health decisions.