Rotator Cuff Physical Exam

Musculoskeletal physical examination is important in diagnosing muscle injury. One of the most common muscle problems is injury to rotator cuff muscles. At our Beverly Hills medical office, experts perform rotator cuff physical exam to check the stability of your shoulder joint.

What is rotator cuff?

The rotator cuff is a group of 4 muscles that protect and stabilize the shoulder joint. Muscles of the rotator cuff include supraspinatus, infraspinatus, subscapularis, and teres minor. The tendons of these muscles insert in your humerus, or upper arm bone, and cover your shoulder joint, securing its stability. They also enable you to rotate and lift your arm smoothly.

What is rotator cuff injury?

Injury to rotator cuff muscles is a common cause of shoulder pain in adults. A rotator cuff tear means that one of the tendons of the rotator cuff muscles is torn, resulting in pain and limited movement of the shoulder joint. A tear in rotator cuff muscles, most commonly affecting the supraspinatus muscle, has two types.

Types of rotator cuff tears

  1. Partial (or incomplete) tear: tendon is damaged but not fully torn
  2. Full thickness (or complete) tear: tendon is fully torn and the muscle is no longer bound to the bone

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Causes

Rotator cuff tears are caused by many factors such as overuse, wear and tear (degeneration) over time, and shoulder fractures. Trauma related to sport injuries is another common cause of rotator cuff tears. Tennis, swimming, baseball, and basketball athletes who strain their shoulder during practice frequently suffer from such tears. Any repetitive overhead activities, like lifting heavy objects, performed for a long time can lead to degeneration of rotator cuff muscle tendons.

Symptoms

Common symptoms of rotator cuff tears include:

  • Shoulder pain – at rest, when raising your arm above your head, or when lying on the affected shoulder
  • Tenderness over your shoulder
  • Weakness and limited movement of shoulder and upper arm
  • A crackling sound when moving your shoulder

Diagnosis

A thorough rotator cuff physical exam is a crucial step in diagnosing tears. Your physician will examine both shoulders, comparing their symmetry and range of motion (ROM). In addition, he or she will evaluate your arm strength using special musculoskeletal tests such as:

  • Drop arm test – to assess your supraspinatus muscle
  • Lift off test – to assess your subscapularis muscle
  • External rotation lag test – to assess your infraspinatus muscle
  • Hornblower’s sign test – to assess your teres minor muscle

In addition to physical examination, other diagnostic tools used include imaging techniques. The most reliable imaging modality to diagnose rotator cuff tears is magnetic resonance imaging (MRI). If you are not comfortable with MRI due to claustrophobia or other problems, ultrasound can also be used. X-rays are used to identify the presence of any bony spurs.

Treatment

There are two forms of treatment for rotator cuff tears. Both aim to relieve shoulder pain and restore motor function of the shoulder joint and upper arm. Depending on the type of tear and the severity of your symptoms, your physician will choose the appropriate treatment plan for you.

Conservative treatment

This treatment plan does not involve surgical repair. Complete rest is a must and pain is managed using analgesic medications like NSAIDs or steroid injections. Heat pads or ice packs can also be used to reduce swelling. Physical therapy and strengthening exercises are recommended to improve rotator cuff function.

Surgical treatment

If your rotator cuff tear is severe or does not respond to conservative therapy, rotator cuff surgery is performed. During surgical repair, an orthopedic surgeon reattaches the tendon to the bone using organic or metal sutures. There are three types of rotator cuff surgery.

  1. Open repair: this option is reserved for large rotator cuff tears that require large incisions to repair muscle tissue
  2. Mini-open repair: this involves arthroscopic intervention to remove damaged tissue followed by an incision to repair muscle tissue
  3. Arthroscopic repair: this is the least invasive option, it involves a very small incision to allow the entry of the arthroscope followed by repair of rotator cuff tendons

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