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Hermans J, Luime J, Meuffels D, et al. Does this patient with shoulder pain have rotator cuff disease?: The Rational Clinical Examination systematic review. JAMA. 2013;310:837-47.
What are the most accurate physical signs for diagnosing rotator cuff disease?
The rotator cuff is the group of 4 ligaments that stabilize the shoulder joint. They connect to the 4 muscles that move the shoulder in various directions.
Rotator cuff disease (RCD) is damage to the rotator cuff from any cause (acute injuries, repetitive strains, degeneration with aging, or inflammation).
RCD is the most common cause of shoulder and arm pain, especially during overhead activities.
However, patients with a chronic full-thickness rotator cuff tear may have painless loss of active motion.
The source of this summary is a meta-analysis of 5 studies (from an initial set of 28) evaluating the examination of referred patients by specialists. Publication period was 2005 to 2010.
The 5 studies covered the examination of 442 shoulders (between 30 and 203 across studies) in 432 patients 20 to 86 years of age (average about 54 years).On average, 64% had RCD.
15 examination tests were included.
Identifying rotator cuff disease
Identifying full-thickness tears
A positive painful arc test result and a positive external rotation resistance test result are the most accurate results for detecting rotator cuff disease.
A positive lag test (external or internal rotation) result is the most accurate for diagnosing full-thickness rotator cuff tears.