injuries poisoning
Rotator Cuff Injury Subacromial Bursitis
Diagnosis of Rotator Cuff Injury
Physical examination Sometimes MRI or arthroscopy Diagnosis is by history and physical examination, including provocative maneuvers (see also Physical Examination of the Shoulder ). The rotator cuff cannot be palpated directly, but it can be assessed indirectly by provocative maneuvers that test its individual muscular components; significant pain or weakness is considered a positive result. Thesupraspinatusis assessed by having the patient resist downward pressure on the arms held in forward flexion with the thumbs pointing downward (empty can, or Jobe test). Theinfraspinatusandteres minorare assessed by having the patient resist external rotation pressure with the arms held at the sides with elbows flexed to 90°; this position isolates rotator cuff muscle function from that of other muscles such as the deltoid. Weakness during this test suggests significant rotator cuff dysfunction (eg, a complete tear). Thesubscapularisis assessed by having the patient place the hand behind the back with the back of the hand resting on the lower back. The examiner lifts the hand off the lower back. The patient should be able to keep the hand off the skin of the back (Gerber lift-off test). TheNeer testchecks for impingement of the rotator cuff tendons under the coracoacromial arch. It is done by placing the arm in forced forward flexion (arm lifted overhead) with the arm fully pronated. TheHawkins testalso checks for impingement. It is done by elevating the arm to 90°, flexing the elbow 90°, and then forcibly rotating the shoulder internally. TheApley scratch testassesses combined shoulder range of motion by having the patient attempt to touch the opposite scapula: Reaching overhead, behind the neck, and to the opposite scapula with the tips of the fingers tests abduction and external rotation; reaching under, behind the back, and across to the opposite scapula with the back of the hand tests adduction and internal rotation. Other areas that may be the source of shoulder pain include the acromioclavicular and sternoclavicular joints, cervical spine, biceps tendon, and scapula. These areas should be assessed for any tenderness or deformity indicating a problem in those areas. Theneckis examined as part of any shoulder evaluation because pain can be referred to the shoulder from the cervical spine (particularly with C5 radiculopathy). Suspected rotator cuff injury can be further evaluated with MRI should a brief course of conservative treatment not result in resolution of symptoms. 