Diagnosis and Management of Partial Thickness Rotator Cuff Tears

A Comprehensive Review

Kevin D. Plancher, MD, MPH; Jaya Shanmugam, MD; Karen Briggs, MPH; Stephanie C. Petterson, MPT, PhD

Disclosures

J Am Acad Orthop Surg. 2021;29(24):1031-1043. 

In This Article

Physical Examination

A comprehensive clinical examination must be conducted in a shoulder gown that allows for visual inspection of the shoulder girdle. The examiner should first rule out any radicular pain originating from the cervical spine. Full active and passive shoulder range of motion (ROM) is often exhibited although should be compared with the contralateral side. A painful arc of motion from approximately 90° to 120° in flexion and/or abduction may be present.[17] Adaptations of increased external rotation at 90° abduction and resultant decreased internal rotation with a normal arc of motion are frequently observed in throwing athletes; however, loss of ROM >20° compared with the contralateral shoulder, known as glenohumeral internal rotation deficit, may be present. Glenohumeral internal rotation deficit is an adaptive process in throwers with posterior capsule tightness and anterior capsule stretching, leading to microinstability and risk of PRCTs when accompanied with internal impingement. RC weakness is rare; therefore, strength testing of the RC and scapular muscles may prove to be normal. Pain with resisted external rotation with the arm at the side is more suggestive of infraspinatus pathology.

Provocative testing is often nonspecific. Positive Neer and Hawkins subacromial impingement signs are associated with PRCTs, although not diagnostic.[5] The internal rotation resistance strength test is done with the patient's shoulder in 90° abduction and 80° to 85° of external rotation. Apparent weakness with resisted internal rotation may suggest internal impingement.[13] Biceps or labral pathology may accompany RC changes and would be evidenced by a positive Speed, O'Brien, or Yergason test. Instability should be evaluated using anterior drawer, sulcus sign, and apprehension/relocation tests, especially in the young, throwing athlete.

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