Top 3 Rotator Cuff Orthopedic Tests
Reading time: 4 minutes
According to the Family Practice journal, “Shoulder pain is the third most common musculoskeletal complaint in primary care.” (1) And 65-70% of all shoulder pain diagnoses involve the rotator cuff. (2)
While MRIs have great utility for detecting rotator cuff pathology, evidence-based chiropractors recognize that most shoulder pain does not require an MRI, so we start with more cost-effective (and nearly equally efficient) rotator cuff assessments and rotator cuff orthopedic tests. *For more on this topic, see the prior blog for When to MRI and When to Refer
This week’s blog will focus on three of the most reliable tests for rotator cuff tears, including a brand-new maneuver showing promising potential. You’ll also learn how to incorporate this test into a straightforward 3-minute rotator cuff exam to help make you the provider of choice for this common problem.
How We Currently Assess Rotator Cuff Tears
Prior ChiroUp blogs have detailed two simple clinical rotator cuff exams that show excellent utility for diagnosing tears:
“A positive external rotation lag sign is the clinical test most likely to indicate that full-thickness tears of the supraspinatus and infraspinatus are present (specificity, 94%).” (3)
ERLS - External Rotation Lag Sign
“Pain during DIME testing had a sensitivity of 96.3% and 92.6% in the coronal and scapular planes, respectively…for supraspinatus pathology of any kind (i.e., tendinopathy, “fraying,” or tearing).” (4)
DIME Test
ChiroUp subscribers can review these tests 24/7 in the Clinical Skills library.
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A New Orthopedic Test for Rotator Cuff Tears
Last month, the Journal of Shoulder & Elbow Surgery detailed a new rotator cuff orthopedic test that showed promising results for identifying rotator cuff pathology. In a study of 100 patients with MRI-defined rotator cuff tears, the Internal Rotation and Shift-Test (IRO/Shift-Test) demonstrated 92% sensitivity and 67% specificity for detecting those lesions. (5) The test also showed “good-to-excellent” intra-rater and inter-rater reliability.
How It’s Done
The patient is instructed to reach behind their back and slide their extended thumb as high up the spine as possible. The clinician measures active shoulder internal rotation by noting the highest spinal level the patient can touch. At the extent of active motion, the clinician applies passive overpressure, moving the arm into greater adduction and internal rotation. Reproduction of anterior shoulder pain is a positive test. (5)
Internal Rotation and Shift-Test
Why It Works
Moving the arm into greater adduction and internal rotation causes the humeral head to shift anteriorly, thus placing tension on the superior rotator cuff.
Watch For These Pitfalls
Forced adduction and internal rotation also stress the biceps tendon. While biceps and rotator cuff tendinopathies are frequent co-conspirators*, sometimes clinicians may need to differentiate these related problems.
*Because of common etiologies, biceps tendinopathy rarely occurs in isolation, and greater than 90% co-exist with other impingement-related pathologies of the shoulder, including rotator cuff tendinopathy/tears, SLAP lesions, and shoulder instability. (6-8)
The most sensitive and specific tests for identifying biceps involvement include (I9):
|
Sensitivity |
Specificity |
|
Bear Hug (0.79) |
Belly Press (0.85) |
|
Upper Cut (0.73) |
Speed’s (0.81) |
Do you want to learn more about problems that co-exist with or mimic rotator cuff pathology? Check out these other popular ChiroUp blogs:
A Practical Clinical Shoulder Exam
Would you like to see how this fits together in clinical practice? Watch this straightforward video tutorial of a 3-minute rotator cuff exam.
Subscribers can use the ChiroUp Shoulder Exam form for a quick reference.
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1. van Doorn PF, de Schepper EI, Rozendaal RM, Ottenheijm RP, van der Lei J, Bindels PJ, Schiphof D. The incidence and management of shoulder complaints in general practice: a retrospective cohort study. Family Practice. 2021 Oct;38(5):582-8. Link
2. Jain NB, Fan R, Higgins LD, Kuhn JE, Ayers GD. Does my patient with shoulder pain have a rotator cuff tear? A predictive model from the ROW cohort. Orthopaedic Journal of Sports Medicine. 2018 Jul 16;6(7):2325967118784897. Link
3. Miller CA, Forrester GA, Lewis JS. The validity of the lag signs in diagnosing full-thickness tears of the rotator cuff: a preliminary investigation. Archives of physical medicine and rehabilitation. 2008 Jun 1;89(6):1162-8. Link
4. Abraham PF, Nazal MR, Varady NH, Gillinov SM, Quinlan NJ, Alpaugh K, Martin SD. The new dynamic isotonic manipulation examination (DIME) is a highly sensitive secondary screening tool for supraspinatus full-thickness tears. Journal of Shoulder and Elbow Surgery. 2020 Nov 1;29(11):2213-20. Link
5. Fieseler G, Laudner K, Sendler J, et al. The internal rotation and shift-test for the detection of superior lesions of the rotator cuff: reliability and clinical performance. JSES Int. 2022;6(3):495-499. Published 2022 Feb 18. doi:10.1016/j.jseint.2022.01.011 Link
6. Churgay CA. Diagnosis and treatment of biceps tendinitis and tendinosis. Am Fam Physician. 2009 Sep 1;80(5):470-6. Link
7. Curtis AS, Snyder SJ. Evaluation and treatment of biceps tendon pathology. The Orthopedic clinics of North America. 1993 Jan;24(1):33-43. Link
8. Abrams JS. Special shoulder problems in the throwing athlete: pathology, diagnosis, and nonoperative management. Clinics in sports medicine. 1991 Oct;10(4):839-61. Link
9. Kibler BW, Sciascia AD, Hester P, Dome D, Jacobs C. Clinical utility of traditional and new tests in the diagnosis of biceps tendon injuries and superior labrum anterior and posterior lesions in the shoulder. Am J Sports Med. 2009 Sep;37(9):1840-7. Link
