A rotator cuff tear is a partial or full tear of one of the four tendons that hold the ball of the shoulder in place, most often the supraspinatus. It usually comes from age-related wear in adults over 40, though a fall or a heavy lift can tear it suddenly.
Key symptoms
- Pain on the outer shoulder, worse with overhead reaching
- Night pain and trouble lying on that side
- Weakness lifting or rotating the arm
- Sudden weakness after a fall in an acute tear
What you find on exam
- Painful arc and weakness on the empty can test (supraspinatus)
- External rotation weakness or lag sign
- Drop arm sign in a large tear
- Neck exam to rule out pain coming from the cervical spine
Tests
- Shoulder X-ray for arthritis or a high-riding humeral head
- Ultrasound or MRI to confirm and size the tear
- MR arthrogram for subtle partial tears in younger athletes
Treatment basics
- Rest from overhead activity, NSAIDs and ice
- Physical therapy to strengthen the cuff and shoulder blade muscles
- Subacromial steroid injection for pain relief in selected patients
- Surgical repair for acute traumatic tears or failed therapy
Red flags
- Sudden loss of arm lifting after a fall or dislocation
- Shoulder pain with fever and a hot joint
- Left shoulder pain with exertional chest pressure or shortness of breath
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.