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Rotator Cuff Disorders

  • Chapter
Physical Examination of the Shoulder

Abstract

The purpose of the physical examination is to confirm the suspicions that are generated by the patient’s history and general survey in order to arrive at the correct diagnosis. Physical examination of patients with rotator cuff disease is particularly challenging due to the wide spectrum of pathologies that can produce similar symptoms and physical findings. Subacromial impingement, subcoracoid impingement, internal impingement, and full-thickness rotator cuff tears all present differently although their physical findings may overlap. A differential-based approach allows the examiner to focus on the suspected pathology which most often leads to an accurate diagnosis. The purpose of this chapter is to explore the pathogenesis and pertinent physical examination findings in patients with subacromial impingement, subcoracoid impingement, internal impingement, and rotator cuff tears.

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References

  1. Dugas JR, Campbell DA, Warren RF, Robie BH, Millett PJ. Anatomy and dimensions of the rotator cuff insertions. J Shoulder Elbow Surg. 2002;11(5):498–503.

    PubMed  Google Scholar 

  2. Burkhart SS. Shoulder arthroscopy. New concepts. Clin Sports Med. 1996;15(4):635–53.

    CAS  PubMed  Google Scholar 

  3. Burkhart SS. Arthroscopic debridement and decompression for selected rotator cuff tears. Clinical results, pathomechanics, and patient selection based on biomechanical parameters. Orthop Clin North Am. 1993;24(1):111–23.

    CAS  PubMed  Google Scholar 

  4. Burkhart SS. Arthroscopic treatment of massive rotator cuff tears: clinical results and biomechanical rationale. Clin Orthop Relat Res. 1991;267:45–56.

    PubMed  Google Scholar 

  5. Lippitt S, Matsen F. Mechanisms of glenohumeral joint stability. Clin Orthop Relat Res. 1993;291:20–8.

    PubMed  Google Scholar 

  6. Sano H, Hatta T, Yamamoto N, Itoi E. Stress distribution within rotator cuff tendons with a crescent-shaped and an L-shaped tear. Am J Sports Med. 2014;41(10):2262–9.

    Google Scholar 

  7. Sano H, Wakabayashi I, Itoi E. Stress distribution in the supraspinatus tendon with partial-thickness tears: an analysis using two-dimensional finite element model. J Shoulder Elbow Surg. 2006;15(1):100–5.

    PubMed  Google Scholar 

  8. Hughes RE, An KN. Force analysis of rotator cuff muscles. Clin Orthop Relat Res. 1996;330:75–83.

    PubMed  Google Scholar 

  9. Bigliani LU, Levine WN. Subacromial impingement syndrome. J Bone Joint Surg Am. 1997;79(12):1854–68.

    CAS  PubMed  Google Scholar 

  10. Neer II CS. Impingement lesions. Clin Orthop Relat Res. 1983;173:70–7.

    PubMed  Google Scholar 

  11. Vaz S, Soyer J, Pries P, Clarac JP. Subacromial impingement: influence of coracoacromial arch geometry on shoulder function. J Bone Spine. 2000;67(4):305–9.

    CAS  Google Scholar 

  12. Lohr JF, Uhthoff HK. The microvascular pattern of the supraspinatus tendon. Clin Orthop. 1990;254:35–8.

    PubMed  Google Scholar 

  13. Flatow E, Coleman W, Kelkar R. The effect of anterior acromioplasty on rotator cuff contact: an experimental computer simulation. J Shoulder Elbow Surg. 1995;4(1):S53–4.

    Google Scholar 

  14. Gill T, McIrvin E, Kocher MS, Horna K, Mair S, Hawkins RJ. The relative importance of acromial morphology and age with respect to rotator cuff pathology. J Shoulder Elbow Surg. 2002;11(4):327–30.

    PubMed  Google Scholar 

  15. Petersilge CA, Witte DH, Sewell BO, Bosch E, Resnick D. Normal regional anatomy of the shoulder. Magn Reson Imaging Clin N Am. 1997;5(4):667–81.

    CAS  PubMed  Google Scholar 

  16. Pieper HG, Radas CB, Krahl H, Blank M. Anatomic variation of the coracoacromial ligament: a macroscopic and microscopic cadaveric study. J Shoulder Elbow Surg. 1997;6(3):291–6.

    CAS  PubMed  Google Scholar 

  17. Matsen FA, Kirby RM. Office evaluation and management of shoulder pain. Orthop Clin North Am. 1982;13(3):45.

    Google Scholar 

  18. Lee HJ, Kim YS, Ok JH, Song HJ. Apoptosis occurs throughout the diseased rotator cuff. Am J Sports Med. 2013;41(10):2249–55.

    PubMed  Google Scholar 

  19. Jobe FW, Moynes DR. Delineation of diagnostic criteria and a rehabilitation program for rotator cuff injuries. Am J Sports Med. 1982;10(6):336–9.

    CAS  PubMed  Google Scholar 

  20. Fremerey R, Bastian L, Siebert WE. The coracoacromial ligament: anatomical and biomechanical properties with respect to age and rotator cuff disease. Knee Surg Sports Traumatol Arthrosc. 2000;8(5):309–13.

    CAS  PubMed  Google Scholar 

  21. Fealy S, April EW, Khazzam M, Armengol-Barallat J, Bigliani LU. The coracoacromial ligament: morphology and study of acromial enthesopathy. J Shoulder Elbow Surg. 2005;14(5):542–8.

    PubMed  Google Scholar 

  22. Chambler AF, Bull AM, Reilly P, Amis AA, Emery RJ. Coracoacromial ligament tension in vivo. J Shoulder Elbow Surg. 2003;12(4):365–7.

    Google Scholar 

  23. Yamamoto N, Muraki T, Sperling JW, Steinmann SP, Itoi E, Cofield RH, An KN. Contact between the coracoacromial arch and the rotator cuff tendons in nonpathologic situations: a cadaveric study. J Shoulder Elbow Surg. 2010;19(5):681–7.

    PubMed  Google Scholar 

  24. Sammarco V. Os acromiale: frequency, anatomy and clinical implications. J Bone Joint Surg Am. 2000;82(3):394–400.

    CAS  PubMed  Google Scholar 

  25. Barbier O, Block D, Dezaly C, Sirveaux F, Mole D. Os acromiale, a cause of shoulder pain, not to be overlooked. Orthop Traumatol Surg Res. 2013;99(4):465–72.

    CAS  PubMed  Google Scholar 

  26. Boehm T, Matzer M, Brazda D, Gholke F. Os acromiale associated with tear of the rotator cuff treated operatively. J Bone Joint Surg Br. 2003;85(4):545–9.

    CAS  PubMed  Google Scholar 

  27. Boehm T, Rolf O, Martetschlaeger F, Kenn W, Gohlke F. Rotator cuff tears associated with os acromiale. Acta Orthop. 2005;76(2):241–4.

    PubMed  Google Scholar 

  28. Mudge MK, Wood VE, Frykman GK. Rotator cuff tears associated with os acromiale. J Bone Joint Surg Am. 1984;66(3):427–9.

    CAS  PubMed  Google Scholar 

  29. Park JG, Lee JK, Phelps CT. Os acromiale associated with rotator cuff impingement: MR imaging of the shoulder. Radiology. 1994;193(a):255–7.

    CAS  PubMed  Google Scholar 

  30. Bigliani L, Ticker J, Flatow E. The relationship of acromial architecture to rotator cuff disease. Clin Sports Med. 1991;10(4):823–38.

    CAS  PubMed  Google Scholar 

  31. Wang JC, Horner G, Brown ED, Shapiro MS. The relationship between acromial morphology and conservative treatment of patients with impingement syndrome. Orthopedics. 2000;23(6):557–9.

    CAS  PubMed  Google Scholar 

  32. Natsis K, Tsikaras P, Totlis T, Gigis I, Skanalakis P, Appell HJ, Koebke J. Correlation between the four types of acromion and the existence of enthesophytes: a study on 423 dried scapulas and review of the literature. Clin Anat. 2007;20(3):267–72.

    CAS  PubMed  Google Scholar 

  33. Hamid N, Omid R, Yamaguchi K, Steger-May K, Stobbs G, Keener JD. Relationship of radiographic acromial characteristics and rotator cuff disease: a prospective investigation of clinical, radiographic and sonographic findings. J Shoulder Elbow Surg. 2012;21(10):1289–98.

    PubMed Central  PubMed  Google Scholar 

  34. Balke M, Schmidt C, Dedy N, Banerjee M, Bouillon B, Liem D. Correlation of acromial morphology with impingement syndrome and rotator cuff tears. Acta Orthop. 2013;84(2):178–83.

    PubMed Central  PubMed  Google Scholar 

  35. Brooks CH, Revell WJ, Heatley FW. A quantitative histological study of the vascularity of the rotator cuff tendon. J Bone Joint Surg Br. 1992;74(1):151–3.

    CAS  PubMed  Google Scholar 

  36. Chang E, Moses D, Babb J, Schweitzer M. Shoulder impingement: objective 3D shape analysis of acromial morphologic features. Radiology. 2006;239(2):497–505.

    PubMed  Google Scholar 

  37. Hyvönen P, Lohi S, Javovaara P. Open acromioplasty does not prevent the progression of an impingement syndrome to a tear. Nine year follow-up of 96 cases. J Bone Joint Surg Br. 1998;80(5):813–6.

    PubMed  Google Scholar 

  38. Weber S. Arthroscopic debridement and acromioplasty versus mini-open repair in the treatment of significant partial-thickness rotator cuff tears. Arthroscopy. 1999;15(2):126–31.

    CAS  PubMed  Google Scholar 

  39. Vanarthos WJ, Monu JU. Type 4 acromion: a new classification. Contemp Orthop. 1995;30(3):227–9.

    CAS  PubMed  Google Scholar 

  40. Sanders TG, Miller MD. A systematic approach to magnetic resonance imaging interpretation of sports medicine injuries of the shoulder. Am J Sports Med. 2005;33(7):1088–105.

    PubMed  Google Scholar 

  41. Tucker TJ, Snyder SJ. The keeled acromion: an aggressive acromial variant – a series of 20 patients with associated rotator cuff tears. Arthroscopy. 2004;20(7):744–53.

    PubMed  Google Scholar 

  42. Aoki M, Ishii S, Usui M. The slope of the acromion and rotator cuff impingement. Orthop Trans. 1986;10:228.

    Google Scholar 

  43. Banas MP, Miller RJ, Totterman S. Relationship between the lateral acromion angle and rotator cuff disease. J Shoulder Elbow Surg. 1995;4(6):454–61.

    CAS  PubMed  Google Scholar 

  44. McGinley JC, Agrawal S, Biswal S. Rotator cuff tears: association with acromion angulation on MRI. Clin Imaging. 2012;36(6):791–6.

    PubMed  Google Scholar 

  45. Baechler M, Kim D. “Uncoverage” of the humeral head by anterolateral acromion and its relationship to full-thickness rotator cuff tears. Mil Med. 2006;171:1035–8.

    PubMed  Google Scholar 

  46. Torrens C, López JM, Puente I, Cáceres E. The influence of the acromial coverage index in rotator cuff tears. J Shoulder Elbow Surg. 2007;16(3):347–51.

    PubMed  Google Scholar 

  47. Nyffeler R, Werner C, Sukthankar A, Schmid M, Gerber C. Association of large lateral extension of the acromion with rotator cuff tears. J Bone Joint Surg Am. 2006;88(4):800–5.

    PubMed  Google Scholar 

  48. Ames JB, Horan MP, Van der Meijden OA, Leake MJ, Millett PJ. Association between acromial index and outcomes following arthroscopic repair of full-thickness rotator cuff tears. J Bone Joint Surg Am. 2012;94(20):1862–9.

    PubMed  Google Scholar 

  49. Kim JR, Ryu KJ, Hong IT, Kim BK, Kim JH. Can a high acromion index predict rotator cuff tears? Int Orthop. 2012;36(5):1019–24.

    PubMed Central  PubMed  Google Scholar 

  50. Musil D, Sadovský P, Rost M, Stehlík J, Filip L. [Relationship of acromial morphology and rotator cuff tears]. Acta Chir Orthop Traumatol Cech. 2012;79(3):238–42.

    Google Scholar 

  51. Hughes RE, Bryant CR, Hall JM, Wening J, Huston LJ, Kuhn JE, Carpenter JE, Blasier RB. Glenoid inclination is associated with full-thickness rotator cuff tears. Clin Orthop Relat Res. 2003;407:86–91.

    PubMed  Google Scholar 

  52. Tétreault P, Krueger A, Zurakowski D, Gerber C. Glenoid version and rotator cuff tears. J Orthop Res. 2004;22(1):202–7.

    PubMed  Google Scholar 

  53. Dogan M, Cay N, Tosun O, Karaglanoglu M, Bozkurt M. Glenoid axis is not related with rotator cuff tears–a magnetic resonance imaging comparative study. Int Orthop. 2012;36(3):595–8.

    PubMed Central  PubMed  Google Scholar 

  54. Tokgoz N, Kanatli U, Voyvoda NK, Gultekin S, Bolukbasi S, Tali ET. The relationship of glenoid and humeral version with supraspinatus tendon tears. Skeletal Radiol. 2007;36(5):509–14.

    PubMed  Google Scholar 

  55. Wong AS, Gallo L, Kuhn JE, Carpenter JE, Hughes RE. The effect of glenoid inclination on superior humeral head migration. J Shoulder Elbow Surg. 2003;12(4):360–4.

    PubMed  Google Scholar 

  56. Gerber C, Snedeker JG, Baumgartner D, Viehöfer AF. Supraspinatus tendon load during abduction is dependent on the size of the critical shoulder angle. A biomechanical analysis. J Orthop Res. 2014;32(7):952–7.

    PubMed  Google Scholar 

  57. Moor BK, Bouaicha S, Rothenfluh DA, Sukthankar A, Gerber C. Is there an association between the individual anatomy of the scapula and the development of rotator cuff tears or osteoarthritis of the glenohumeral joint? A radiological study of the critical shoulder angle. Bone Joint J. 2013;95-B(7):935–41.

    CAS  PubMed  Google Scholar 

  58. Moor BK, Wieser K, Slankamenac K, Gerber C, Bouaicha S. Relationship of individual scapular anatomy and degenerative rotator cuff tears. J Shoulder Elbow Surg. 2014;23(4):536–41.

    PubMed  Google Scholar 

  59. Ogata S, Uhthoff HK. Acromial enthesopathy and rotator cuff tear: a radiologic and histologic postmortem investigation of the coracoacromial arch. Clin Orthop Relat Res. 1990;254:39–48.

    PubMed  Google Scholar 

  60. Burkhart SS, Morgan CD, Kibler WB. The disabled throwing shoulder: spectrum of pathology. Part I, pathoanatomy and biomechanics. Arthroscopy. 2003;19:404–20.

    PubMed  Google Scholar 

  61. Chansky HA, Iannotti JP. The vascularity of the rotator cuff. Clin Sports Med. 1991;10(4):807–22.

    CAS  PubMed  Google Scholar 

  62. Lindblom K. On pathogenesis of ruptures of the tendon aponeurosis of the shoulder joint. Acta Radiol. 1939;20:563–77.

    Google Scholar 

  63. Ling SC, Chen CF, Wan RX. A study on the vascular supply of the supraspinatus tendon. Surg Radiol Anat. 1990;12(3):161–5.

    CAS  PubMed  Google Scholar 

  64. Moseley HF, Goldie I. The arterial pattern of the rotator cuff of the shoulder. J Bone Joint Surg Br. 1963;48:780–9.

    Google Scholar 

  65. Rathbun JB, Macnab I. The microvascular pattern of the rotator cuff. J Bone Joint Surg Br. 1970;52(3):540–53.

    CAS  PubMed  Google Scholar 

  66. Benson RT, McDonnell SM, Knowles HJ, Rees JL, Carr AJ, Hulley PA. Tendinopathy and tears of the rotator cuff are associated with hypoxia and apoptosis. J Bone Joint Surg Br. 2010;92(3):448–53.

    CAS  PubMed Central  PubMed  Google Scholar 

  67. Lundgreen K, Lian Ø, Scott A, Engebretsen L. Increased levels of apoptosis and p53 in partial-thickness supraspinatus tendon tears. Knee Surg Sports Traumatol Arthrosc. 2013;21(7):1636–41.

    PubMed  Google Scholar 

  68. Millar NL, Reilly JH, Kerr SC, Campbell AL, Little KJ, Leach WJ, Rooney BP, Murrell GA, McInnes IB. Hypoxia: a critical regulator of early human tendinopathy. Ann Rheum Dis. 2012;71(2):302–10.

    CAS  PubMed  Google Scholar 

  69. Clark JM, Harryman II DT. Tendons, ligaments, and capsule of the rotator cuff: gross and microscopic anatomy. J Bone Joint Surg Am. 1992;74(5):713–25.

    CAS  PubMed  Google Scholar 

  70. Hawkins RJ, Kennedy JC. Impingement syndrome in athletes. Am J Sports Med. 1980;8(3):151–7.

    CAS  PubMed  Google Scholar 

  71. Park HB, Yokota A, Gill HS, El Rassi G, McFarland EG. Diagnostic accuracy of clinical tests for the different degrees of subacromial impingement syndrome. J Bone Joint Surg Am. 2005;87(7):1446–55.

    PubMed  Google Scholar 

  72. Chew K, Pua YH, Chin J, Clarke M, Wong YS. Clinical predictors for the diagnosis of supraspinatus pathology. Physiother Singap. 2010;13(2):12–8.

    Google Scholar 

  73. Fodor D, Poanta L, Felea I, et al. Shoulder impingement syndrome: correlations between clinical tests and ultrasonographic findings. Orthop Traumatol Rehabil. 2009;11(2):120–6.

    Google Scholar 

  74. Fowler EM, Horsley IG, Rolf CG. Clinical and arthroscopic findings in recreationally active patients. Sports Med Arthrosc Rehabil Ther Technol. 2010;2:2.

    PubMed Central  PubMed  Google Scholar 

  75. Kadaba MP, Cole A, Wootten ME, McCann P, Reid M, Mulford G, April E, Bigliani L. Intramuscular wire electromyography of the subscapularis. J Orthop Res. 1992;10(3):394–7.

    CAS  PubMed  Google Scholar 

  76. Michener LA, Walsworth MK, Doukas WC, Murphy KP. Reliability and diagnostic accuracy of 5 physical examination tests and combination of tests for subacromial impingement. Arch Phys Med Rehabil. 2009;90(11):1898–903.

    PubMed  Google Scholar 

  77. Salaffi F, Ciapetti A, Carotti M, Gasparini S, Filippucci E, Grassi W. Clinical value of single versus composite provocative clinical tests in the assessment of painful shoulder. J Clin Rheumatol. 2010;16(3):105–8.

    PubMed  Google Scholar 

  78. Silva L, Andréu JL, Muñoz P, Pastrana M, Millán I, Sanz J, Barbadillo C, Fernández-Castro M. Accuracy of physical examination in subacromial impingement syndrome. Rheumatology (Oxford). 2008;47(5):679–83.

    CAS  Google Scholar 

  79. Kelly SM, Brittle N, Allen GM. The value of physical tests for subacromial impingement syndrome: a study of diagnostic accuracy. Clin Rehabil. 2010;24(2):149–58.

    PubMed  Google Scholar 

  80. Toprak U, Ustuner E, Ozer D, Uyanık S, Baltacı G, Sakızlıoglu SS, Karademir MA, Atay AO. Palpation tests versus impingement tests in Neer stage I and II subacromial impingement syndrome. Knee Surg Sports Traumatol Arthrosc. 2013;21(2):424–9.

    PubMed  Google Scholar 

  81. Hegedus EJ, Goode AP, Cook CE, Michener L, Myer CA, Myer DM, Wright AA. Which physical examination tests provide clinicians with the most value when examining the shoulder? Update of a systematic review with meta-analysis of individual tests. Br J Sports Med. 2012;46(14):964–78.

    PubMed  Google Scholar 

  82. Poppen NK, Walker PS. Forces at the glenohumeral joint in abduction. Clin Orthop Relat Res. 1978;135:165–70.

    PubMed  Google Scholar 

  83. Dumontier C, Sautet A, Gagey O, Apoil A. Rotator interval lesions and their relation to coracoid impingement syndrome. J Shoulder Elbow Surg. 1999;8(2):130–5.

    CAS  PubMed  Google Scholar 

  84. Ferrick MR. Coracoid impingement: a case report and review of the literature. Am J Sports Med. 2000;28(1):117–9.

    CAS  PubMed  Google Scholar 

  85. Gerber C, Terrier F, Ganz R. The role of the coracoid process in the chronic impingement syndrome. J Bone Joint Surg Br. 1985;67(5):703–8.

    CAS  PubMed  Google Scholar 

  86. Martetschläger F, Rios D, Boykin RE, Giphart JE, de Waha A, Millett PJ. Coracoid impingement: current concepts. Knee Surg Sports Traumatol Arthrosc. 2012;20(11):2148–55.

    PubMed  Google Scholar 

  87. Lo IK, Burkhart SS. The etiology and assessment of subscapularis tendon tears: a case for subcoracoid impingement, the roller-wringer effect, and TUFF lesions of the subscapularis. Arthroscopy. 2003;19(10):1142–50.

    PubMed  Google Scholar 

  88. Richards DP, Burkhart SS, Campbell SE. Relation between narrowed coracohumeral distance and subscapularis tears. Arthroscopy. 2005;21(10):1223–8.

    PubMed  Google Scholar 

  89. Goldthwait JE. An anatomic and mechanical study of the shoulder joint, explaining many of the cases of painful shoulder, many of the recurrent dislocations and many cases of brachial neuralgias or neuritis. Am J Orthop Surg. 1909;6:579–606.

    Google Scholar 

  90. Bhatia D, de Beer J, Du Toit D. Coracoid process anatomy: implications in radiographic imaging and surgery. Clin Anat. 2007;20:774–84.

    PubMed  Google Scholar 

  91. Dines D, Warrant R, Inglis A, Pavlov H. The coracoid impingement syndrome. J Bone Joint Surg Br. 1990;72(2):314–6.

    CAS  PubMed  Google Scholar 

  92. Gumina S, Postacchini F, Orsina L, Cinotti G. The morphometry of the coracoid process – its aetiologic role in subcoracoid impingement syndrome. Int Orthop. 1999;23(4):198–201.

    CAS  PubMed Central  PubMed  Google Scholar 

  93. Mallon WJ, Brown HR, Vogler 3rd JB, Martinez S. Radiographic and geometric anatomy of the scapula. Clin Orthop Relat Res. 1992;277:142–5.

    PubMed  Google Scholar 

  94. Tracy MR, Trella TA, Mazarian LN, Tuohy CJ, Williams GR. Sonography of the coracohumeral interval: a potential technique for diagnosing coracoid impingement. J Ultrasound Med. 2010;29(3):337–41.

    PubMed  Google Scholar 

  95. Ferreira Neto A, Almeida A, Maiorino R, Zoppi Filho A, Benegas E. An anatomical study of the subcoracoid space. Clinics (Sao Paulo). 2006;61(5):467–72.

    Google Scholar 

  96. Jobe CM. Posterior superior glenoid impingement: expanded spectrum. Arthroscopy. 1995;11(5):530–6.

    CAS  PubMed  Google Scholar 

  97. Jobe CM. Superior glenoid impingement: current concepts. Clin Orthop Relat Res. 1996;330:98–107.

    PubMed  Google Scholar 

  98. McFarland EG, Hsu CY, Neira C, O’Neil O. Internal impingement of the shoulder: a clinical and arthroscopic analysis. J Shoulder Elbow Surg. 1999;8(5):458–60.

    CAS  PubMed  Google Scholar 

  99. Walch G, Boileau P, Noel E, Donell ST. Impingement of the deep surface of the supraspinatus tendon on the posterosuperior glenoid rim: an arthroscopic study. J Shoulder Elbow Surg. 1992;1(5):238–45.

    CAS  PubMed  Google Scholar 

  100. Walch G, Liotard JP, Boileau P, Noёl E. Postero-superior glenoid impingement. Another impingement of the shoulder. J Radiol. 1993;74(1):47–50.

    CAS  PubMed  Google Scholar 

  101. Wolf EM, Agrawal V. Transdeltoid palpation (the rent test) in the diagnosis of rotator cuff tears. J Shoulder Elbow Surg. 2001;10(5):470–3.

    CAS  PubMed  Google Scholar 

  102. Kim HM, Teefey SA, Zelig A, Galatz LM, Keender JD, Yamaguchi K. Shoulder strength in asymptomatic individuals with intact compared with torn rotator cuffs. J Bone Joint Surg Am. 2009;91(2):289–96.

    PubMed Central  PubMed  Google Scholar 

  103. Yamaguchi K, Sher JS, Andersen WK, Garretson R, Uribe JW, Hechtman K, Neviaser RJ. Glenohumeral motion in patients with rotator cuff tears: a comparison of asymptomatic and symptomatic shoulders. J Shoulder Elbow Surg. 2000;9(1):6–11.

    CAS  PubMed  Google Scholar 

  104. Yamaguchi K, Tetro AM, Blam O, Evanoff BA, Teefey SA, Middleton WD. Natural history of asymptomatic rotator cuff tears: a longitudinal analysis of asymptomatic tears detected sonographically. J Shoulder Elbow Surg. 2001;10(3):199–203.

    CAS  PubMed  Google Scholar 

  105. Codman EA. The shoulder: rupture of the supraspinatus tendon and other lesions in or about the subacromial bursa. Chap. 5. Boston: Thomas Todd; 1934. p. 123–77.

    Google Scholar 

  106. Ponce BA, Kundukulam JA, Sheppard ED, Determann JR, McGwin G, Narducci CA, Crowther MJ. Rotator cuff crepitus: could Codman really feel a cuff tear? J Shoulder Elbow Surg. 2014;23(7):1017–22.

    PubMed  Google Scholar 

  107. Lyons AR, Tomlinson JE. Clinical diagnosis of tears of the rotator cuff. J Bone Joint Surg Br. 1992;74(3):414–5.

    CAS  PubMed  Google Scholar 

  108. Kelly BT, Kadrmas WR, Speer KP. The manual muscle examination for rotator cuff strength. An electromyographic investigation. Am J Sports Med. 1996;24(5):581–8.

    CAS  PubMed  Google Scholar 

  109. Itoi E, Minagawa H, Yamamoto N, Seki N, Abe H. Are pain location and physical examinations useful in locating a tear site of the rotator cuff? Am J Sports Med. 2006;34(2):256–64.

    PubMed  Google Scholar 

  110. Kim E, Jeong HJ, Lee KW, Song JS. Interpreting positive signs of the supraspinatus test in screening for torn rotator cuff. Acta Med Okayama. 2006;60(4):223–38.

    PubMed  Google Scholar 

  111. Bak K, Sørensen AK, Jørgensen U, Nygaard M, Krarup AL, Thune C, Sloth C, Pedersen ST. The value of clinical tests in acute full-thickness tears of the supraspinatus tendon: does a subacromial lidocaine injection help the clinical diagnosis? A prospective study. Arthroscopy. 2010;26(6):734–42.

    PubMed  Google Scholar 

  112. Miller CA, Forrester GA, Lewis JS. The validity of the lag signs in diagnosing full-thickness tears of the rotator cuff: a preliminary investigation. Arch Phys Med Rehabil. 2008;89(6):1162–8.

    PubMed  Google Scholar 

  113. Hertel R, Ballmer FT, Lombert SM, Gerber C. Lag signs in the diagnosis of rotator cuff rupture. J Shoulder Elbow Surg. 1996;5(4):307–13.

    CAS  PubMed  Google Scholar 

  114. Blonna D, Cecchetti S, Tellini A, Bonasia DE, Rossi R, Southgate R, Castoldi F. Contribution of the supraspinatus to the external rotator lag sign: kinematic and electromyographic pattern in an in vivo model. J Shoulder Elbow Surg. 2010;19(3):392–8.

    PubMed  Google Scholar 

  115. Castoldi F, Blonna D, Hertel R. External rotation lag sign revisited: accuracy for diagnosis of full thickness supraspinatus tear. J Shoulder Elbow Surg. 2009;18(4):529–34.

    PubMed  Google Scholar 

  116. Bartsch M, Greiner S, Haas NP, Scheibel M. Diagnostic values of clinical tests for subscapularis lesions. Knee Surg Sports Traumatol Arthrosc. 2010;18(12):1712–77.

    PubMed  Google Scholar 

  117. Yoon JP, Chung SW, Kim SH, Oh JH. Diagnostic value of four clinical tests for the evaluation of subscapularis integrity. J Shoulder Elbow Surg. 2013;22(9):1186–92.

    PubMed  Google Scholar 

  118. Naredo E, Aguado P, De Miguel E, Uson J, Mayordomo L, Gijon-Baños J, Martin-Mola E. Painful shoulder: comparison of physical examination and ultrasonographic findings. Ann Rheum Dis. 2002;61(2):132–6.

    CAS  PubMed Central  PubMed  Google Scholar 

  119. Kim HA, Kim SH, Seo YI. Ultrasonographic findings of painful shoulders and correlation between physical examination and ultrasonographic rotator cuff tear. Mod Rheumatol. 2007;17(3):213–9.

    PubMed  Google Scholar 

  120. Barth JR, Burkhart SS, DeBeer JF. The bear-hug test: a new and sensitive test for diagnosing a subscapularis tear. Arthroscopy. 2006;22(10):1076–84.

    PubMed  Google Scholar 

  121. Furuqui S, Wijdicks C, Foad A. Sensitivity of physical examination versus arthroscopy in diagnosis subscapularis tendon injury. Orthopedics. 2014;37(1):e29–33.

    Google Scholar 

  122. Costouros JG, Gerber C, Warner JJP. Latissimus dorsi tendon transfer. In: ElAttrache NS, Mirzayan R, Harnder CD, Sekiya JK, editors. Surgical techniques in sports medicine. 1st ed., Chap. 8. Philadelphia: Lippincott Williams & Wilkins; 2007.

    Google Scholar 

  123. Stefko JM, Jobe FW, VanderWilde RS, Carden E, Pink M. Electromyographic and nerve block analysis of the subscapularis liftoff test. J Shoulder Elbow Surg. 1997;6(4):347–55.

    CAS  PubMed  Google Scholar 

  124. Chao S, Thomas S, Yucha D, Kelly 4th JD, Driban J, Swanik K. An electromyographic assessment of the “bear hug”: an examination for the evaluation of the subscapularis muscle. Arthroscopy. 2008;24(11):1265–70.

    PubMed  Google Scholar 

  125. Greis PE, Kuhn JE, Schultheis J, Hintermeister R, Hawkins R. Validation of the lift-off tests and analysis of subscapualris activity during maximal internal rotation. Am J Sports Med. 1996;24(5):589–93.

    CAS  PubMed  Google Scholar 

  126. Nemeth G, Kronberg M, Brostrom LA. Electromyogram (EMG) recordings from the subscapularis muscle: description of a technique. J Orthop Res. 1990;8(1):151–3.

    CAS  PubMed  Google Scholar 

  127. Tokish JM, Decker MJ, Ellis HB, Torry MR, Hawkins RJ. The belly-press test for the physical examination of the subscapularis muscle: electromyographic validation and comparison to the lift-off test. J Shoulder Elbow Surg. 2003;12(5):427–30.

    PubMed  Google Scholar 

  128. Pennock AT, Pennington WW, Torry MR, Decker MJ, Vaishnav SB, Provencher MT, Millett PJ, Hackett TR. The influence of arm and shoulder position on the bear-hug, belly-press and lift-off tests: an electromyographic study. Am J Sports Med. 2011;39(11):2338–46.

    PubMed  Google Scholar 

  129. Walch G, Boulahia A, Calderone S, Robinson AH. The ‘dropping’ and ‘hornblower’s’ signs in evaluation of rotator-cuff tears. J Bone Joint Surg Br. 1998;80(4):624–8.

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Steadman Philippon Research Institute, Vail, CO, USA

    Ryan J. Warth M.D.

  2. The Steadman Clinic, Steadman Philippon Research Institute, Vail, CO, USA

    Peter J. Millett M.D., M.Sc.

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Warth, R.J., Millett, P.J. (2015). Rotator Cuff Disorders. In: Physical Examination of the Shoulder. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-2593-3_4

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