Rotator cuff strain diagnosis involves a number of specific tests. Other shoulder injuries have similar symptoms so it is important to get an accurate diagnosis. Here we explain the assessment tests a therapist might use to diagnose a torn rotator cuff.
Torn rotator cuff symptoms at the time of injury will include:
- Sudden pain in the shoulder which can range from quite mild to severe.
- It is sometimes accompanied by a feeling that you have torn something in the shoulder.
- Pain may also radiate down into your arm.
- Sometimes a snapping sound may be heard, particularly if the injury is more severe
- You will often be unable to sleep on the injured shoulder as a result of the pain.
- You may also have signs of shoulder impingement. This is where the tendon pinches between the ball and socket of the shoulder joint, especially when moving your arm overhead.
If the injury is initially mild then you may have continued to train, in which case your pain may get gradually worse over time. Eventually, you will notice weakness in the shoulder to the point where you are unable to lift your arm up and out to the side.
Pain is increased with movement and when stretching the shoulder. There is likely to be a significant loss of function although in mild cases the athlete may attempt to play on. The injured shoulder will have point tenderness at the location of the tear when pressing in. The muscles around the shoulder joint may be going into spasm and swelling may be visible. In more severe cases the muscle involved may appear deformed.
When should I see a doctor?
- Seek medical attention if the pain persists for more than 2-3 days.
- You are unable to work due to the pain
- Unable to reach up, or to the side with the affected arm after 2-3 days.
- If you cannot move your shoulder and arm at all.
Rotator cuff diagnosis & assessment tests
There are a number of shoulder injuries which may have similar symptoms. So to diagnoise rotator cuff injuries a professional therapist will perform some specific tests. These help isolate the rotator cuff muscles and reproduce symptoms.
Empty can test – This is a common rotator cuff strain diangosis test. You will be asked to put your arm out in front of you at a 45-degree angle to your body, with the thumb pointing to the floor (as if holding an empty can). The therapist will ask you to raise your arm whilst they resist your movement. This tests the Supraspinatus tendon.
Drop Arm Test (Codman’s Test) – Your arm will be moved above your head, and you’re asked to gently lower your arm to your side. If you can’t do this slowly and under control or have severe pain in doing so, it suggests a tear in the rotator cuff, specifically Supraspinatus.
Abrasion Sign – You will be asked to sit and raise your arm to your side with the elbow bent. You will be asked to rotate your arm forwards and backward. If there is any crunching noise (crepitus) there may be some inflammation or degenerative changes.
Neer’s Sign – The therapist will position your arm with the thumb facing down and at a 45-degree angle to your body. They will then lift your arm up, above your head. If you experience pain or discomfort, you may have an impingement of supraspinatus.
Hawkins-Kennedy Test – Your arm will be raised in front of you to 90° and the elbow bent. The therapist will then medially rotate (turn the wrist down and elbow up) the arm. If this causes pain you probably have an impingement of Supraspinatus.