Clinical Tests Diagnostic for Rotator Cuff Tear

This clinical outcomes study aimed to determine the commonly used shoulder tests predictive for rotator cuff tear (RCT). The study was carried out in 2 parts involving 400 patients who attended the senior author’s practice (n = 100/group). Part I compared patients with isolated RCTs and a “No-RCT” group. Part II compared RCT patients (some with isolated RCTs, others with RCTs and combined pathology) and No-RCT patients. Patients were imaged, preoperatively examined with clinical shoulder tests, and given presurgical diagnostic arthroscopy if warranted by their shoulder injury. Part I revealed 4 clinically diagnosed features significantly more common in patients with isolated RCTs than in No-RCT patients. Part II validated the findings, showing remarkably similar results. The drop arm sign (10% sensitivity, 100% specificity) affected a small proportion of subjects but where present was a strong indicator for RCT. Three other diagnostic features [supraspinatus weakness, weakness in external rotation, and impingement (SERI) tests] were highly predictive of RCT when all were positive in a subject (likelihood ratio = 12:1). If all SERI tests were negative, RCT was unlikely to be present (likelihood ratio = 0.06:1). The predictive power of this clinical test combination compares favorably with predictive powers reported for magnetic resonance imaging and ultrasound.