Rotator Cuff Assessment & Diagnosis

Rotator cuff tear symptoms consist of sudden onset pain in the shoulder, often from throwing or overhead shots in racket sports. Here we explain how a professional will diagnose a rotator cuff strain.

The following examples are for information purposes only. We highly recommend seeing a sports injury professional or Doctor to receive a full assessment of your injury.

Torn rotator cuff symptoms

Symptoms will usually consist of a sudden pain in the shoulder which can range from quite mild to severe. Pain may also radiate down into the arm and a snapping sound may be heard, particularly if the injury is more severe.

It often occurs in throwing sports such as Javelin throwing, Baseball and Cricket as well as in racket sports when playing overhead shots. Overdoing certain weight training exercises or using poor technique can also cause a tear in the muscle. The athlete may have difficulty sleeping on the injured shoulder as a painful ache develops and there may be signs of impingement where the tendon pinches between the ball and socket of the shoulder joint when moving the arm out over head height.

Pain is increased with movement and when stretching the shoulder. There is likely to be 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 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, are unable to reach up or to the side with the affected arm after 2-3 days or move the shoulder and arm at all.

Rotator cuff assessment tests

There are a number of shoulder injuries which may have similar symptoms so a professional therapist will perform some specific tests to help isolate the rotator cuff muscles and reproduce symptoms.

This usually consists of a subjective assessment where the patient is asked questions concerning the injury and their medical history, and an objective assessment where the therapist examines the injury.


Shoulder assessment tests

Observation - The therapist will examine the shoulder, looking for swelling, bruising, muscle wasting, postural issues etc. It is important that the injured side is compared to the unaffected side at all times.

Palpation - The therapist will feel all around the shoulder, asking if there are any painful points and also feeling for muscular tightness and changes in skin temperature.

Range of motion - The therapist will test the range of motion at the shoulder, both actively (the patient moves themselves) and passively (the therapist moves the arm and the patient relaxes). This should always be compared to the uninjured side for what is normal for each individual

Resisted muscle tests - The therapist will ask you to move your shoulder against resistance (usually provided by them pushing against you). Weakness compared to the uninjured side or pain during shoulder rotation or abduction indicates a rotator cuff injury.

Special tests

Rotator cuff injury symptoms can be reproduced for the purpose of diagnosis through a range of tests:

Empty can 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 backwards. 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.

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