If you have pain in your shoulder or can’t lift your arm, you might have a rotator cuff tear. Beyond googling your symptoms and self-diagnosing, consider trying a few of the special tests we PTs use in the clinic to assess a rotator cuff tear.
To assess a rotator cuff tear, I usually ask my patients to perform 3-4 tests, but you could try as many as 5 on your own at home.
5 Tests to Diagnose a Rotator Cuff Tear
Below are 5 easy Physical Therapy tests you can use to identify whether your rotator cuff is compromised or torn.
If have someone else at home capable of following simple directions, ask them to help you by applying oppositional force. Otherwise, if you’re home alone, no worries – you can just use your good arm to test the troubled one.
1. Empty Can Test
This test targets one of the rotator cuff muscles that most commonly tears at the tendon: the supraspinatus.
To perform the empty can test, fully extend your bad arm and raise it to shoulder height, slightly outward from your body. Turn your hand downward, as if you are emptying a can or glass. Your palm should be open and your thumb pointing to the floor.
Next, using your other arm, press down on your raised arm at the elbow. Try to resist the motion. If someone is nearby, you could ask them to press down on your arm for you.
As you try to resist the pressure, pay attention to any pain or weakness you perceive in your arm, especially compared to your other arm. Pain or weakness may indicate a torn or compromised supraspinatus tendon.
2. Drop Arm Test
A rotator cuff tear will make it difficult for you to control your arm as it lowers, especially if any one of the 4 stabilizers of the rotator cuff are compromised.
To perform the drop arm test, simply raise your arm overhead in an arc, with as much range as possible. Now reverse the arc and lower your arm slowly, without assistance. If you cannot control the motion or if your arm drops suddenly, your rotator cuff might be compromised by a severe strain or tear at the supraspinatus tendon.
3. Lag Sign Test
While standing or sitting upright, bend your bad arm at the elbow to 90 degrees.
Using your opposite arm or a friend’s assistance, rotate your arm away from your body slightly, as if you’re about to throw a ball. Now remove any assistance and try to maintain this position.
If your arm drops or moves, you have a positive lag sign and your supraspinatus, infraspinatus, or teres minor tendon may be compromised or torn.
4. Infraspinatus Test
Your rotator cuff comprises 3 external rotators, one of which is the infraspinatus.
To isolate this muscle, make a loose fist and bend your bad arm at the elbow, so that your forearm is at 90º and the top of your knuckles faces forward. Keeping the elbow tight to your waist, apply pressure inward on your bad arm and try to resist it.
If you feel pain or weakness or are unable to hold the position, there’s a good chance you have a compromised or torn infraspinatus.
5. Lift-Off Test
This test will help you identify a tear or compromise in the subscapularis tendon, which moves the shoulder into internal rotation.
To perform the test, place the back of your hand against the center of your low back. Now try lifting your hand off your back. If you’re unable to do so without pain or weakness (or at all), you might have a subscapularis compromise or tear.
Diagnosing a Rotator Cuff Tear: Summary
So to review, I recommend the following tests for a rotator cuff tear:
- Empty Can Test
- Drop Arm Test
- Lag Sign
- Infraspinatus Test
- Lift-Off Test
If you conclude from these tests that you have a torn rotator cuff, be sure to follow up with your doctor or physical therapist.
Special Tests for Rotator Cuff Tear
Physical Therapists conduct special tests as part of their overall assessment. Before provoking symptoms with orthopedic tests, your PT will gather as much information as possible – from your medical history, through observation, and based on how you complete certain movement tests.
Although a movement test can be a telltale sign of an injury, your PT will use it simply as a tool to confirm or piece together a diagnosis. Therefore, it’s a good idea to perform more than one test so that you can confirm the result and narrow down the issue.
In the meantime, you can learn more about rotator cuff tears here. Your PT may eventually recommend you do these 10 exercises to treat your rotator cuff.
What is the Rotator Cuff?
The rotator cuff is a group of four muscles in your shoulder: namely, the Supraspinatus, Infraspinatus, Teres minor, and Subscapularis (or SITS, if you want a helpful mnemonic). They encapsulate the shoulder joint, called the glenohumeral joint, which attaches your upper arm to your scapula.
The rotator cuff has 2 primary jobs: 1) stabilize the shoulder and 2) assist movement. As a ball-and-socket joint, the shoulder is particularly mobile – yet particularly unstable. The rotator cuff muscles help stabilize this important joint through abduction, internal rotation and external rotation.
Let’s take a look at the role each muscle plays in performing these duties.
The Muscles of the Rotator Cuff
The supraspinatus muscle is the primary muscle that assists abduction, or moving your arm out and away from your body (as if you’re about to make a snow angel). To perform that motion, you use the supraspinatus muscle in the first 15 degrees of abduction before other shoulder muscles like the deltoid and trapezius take over.
Unfortunately, the supraspinatus muscle is the most commonly injured of the rotator cuff muscle. This is partially due to its location and susceptibility to wear and tear.
The infraspinatus and teres minor muscles work together to rotate the shoulder outward in a hinge-like motion called external rotation. These two, relatively small muscles are located on the back of your shoulder blade. They attach to the humerus (your upper arm bone), rotating it outward when contracted.
The largest and 4th rotator cuff muscle, the subscapularis, rotates the arm inward for internal rotation (the reverse of external rotation). This muscle is also the strongest of the 4, with the ability to generate as much force as the other 3 rotator cuff muscles combined.
All four of these muscles work together to help stabilize the head of the humerus within the shoulder socket. Straining or tearing any of the rotator cuff muscles can lead to shoulder instability, weakness, and pain.
Rotator Cuff Injuries
A rotator cuff tear is a remarkably common shoulder injury, affecting over 2 million people annually. The tear is technically a separation of tendon from bone, often beginning with the supraspinatus tendon and then spreading to the rest of the rotator cuff.
If the tear affects one portion of the cuff but doesn’t entirely sever it, the injury is considered a “partial” rotator cuff tear, as opposed to a “full thickness” rotator cuff tear.
What Causes a Rotator Cuff Tear?
There are two main causes of rotator cuff tears: 1) acute injury or 2) degeneration.
The rotator cuff may tear under sudden stress, such as an athletic injury or trauma. In most cases, however, the tear develops slowly from gradual overuse or general wear and tear.
Rotator cuff tears are much more common among adults over the age of 40. That’s because degenerative conditions such as muscle weakness, lack of blood supply, and bone spurs can all contribute to a gradual tear.
Identifying and Diagnosing a Rotator Cuff Tear
Because rotator cuff tears are often slow to develop, initially you may experience only minor pain from overhead movements. But as the injury progresses, pain and weakness will become more prominent.
Along with other measures, PTs use a few special tests to help diagnose a rotator cuff tear. These simple movements can indicate weakness, pain, or compromise in each rotator cuff muscle.
The most salient symptom of any rotator cuff tear is shoulder pain while at rest, especially when lying on the affected shoulder. Other symptoms include pain or weakness when lifting, lowering, or rotating the arm. Some people experience a popping or clicking sensation when moving their arm.
Either way, an injured rotator cuff will impede basic tasks, such as dressing or reaching to fix your hair.
Can the Rotator Cuff Heal Itself?
Unfortunately, a rotator cuff cannot heal itself; the injured tendon will not reattach to the bone on its own. Even after rotator cuff repair surgery, the strength of your shoulder will be compromised. That’s why early detection of a rotator cuff tear is key to minimizing damage and restoring function.
Although a rotator cuff tear will not heal on its own, research shows that non-surgical treatments can bring considerable relief to a rotator cuff tear, whether large or small.
Treating a Torn Rotator Cuff
Obviously, rest is the primary non-surgical treatment for a torn rotator cuff. You will also need to considerably modify daily activities to avoid worsening the tear.
Meanwhile, you can relieve the pain with ice, anti-inflammatory medications, or even steroids. Depending on the severity of the tear, some light exercise will help ameliorate pain and improve range of motion.
Rotator Cuff Repair Surgery
The majority of rotator cuff tears don’t require surgery. However, if your shoulder pain and weakness persist for several months despite careful treatment, you may need to undergo a surgical rotator cuff repair.
There are three different methods for a rotator cuff repair:
1) open repair through a traditional, surgical incision at the shoulder
2) arthroscopic repair through a camera and miniature surgical instruments
3) mini-open repair, which combines arthroscopy with open surgery through a considerably small incision.
Each of these 3 surgical procedures has its own advantages and disadvantages. Your doctor may recommend one based on your injury and other factors.
After surgery, your particular recovery process will depend on your age, overall health, and post-operative care.
Physical Therapy for Rotator Cuff Tear
No matter the size or seriousness of your rotator cuff tear, the road to recovery will include physical therapy rehabilitation.
In fact, physical therapy may help you avoid surgery altogether. By gently strengthening the untorn portion of your rotator cuff, you’ll restore some function and strength in your shoulder without undergoing surgery. Check out these simple, non-surgical rotator cuff exercises to relieve shoulder pain and improve mobility.
But if your case does require surgery, you might have to wait a couple months after the operation to begin physical therapy treatment. You’ll need to protect the repair and avoid moving it while it heals.
Regardless, it’s best to consult with your PT and orthopedic physician for your treatment options. You may be able to find relief with PT alone, but if the injury is severe and surgery is recommended, you’re better off going ahead with the surgery.
Don’t Delay Treatment
Whether it’s physical therapy or surgical repair, seeking immediate treatment will give your rotator cuff the best shot at a full or near-full recovery.
By contrast, putting off vital intervention will lead to further degeneration and potentially a larger tear. So work with your PT to strengthen the muscle fibers you still have. Whether or not you get surgery, Physical Therapy will improve your strength and reduce the severity of your injury.
