Acute Injury
"Tearing" sensation in shoulder followed by severe pain / inability to raise arm
Inability to abduct or externally rotate arm against even minimal resistance
Drop arm test is positive
Local swelling
Chronic Injury
Gradual and progressive pain, worse at night
Pain localizes to lateral aspect of upper arm
Arm elevation, external rotation, and lifting objects worsens the pain
Exam
Disuse atrophy may be present in chronic<unk> s
TTP lateral aspect of upper arm or in subacromial region
"Tearing" sensation in shoulder followed by severe pain / inability to raise arm
Inability to abduct or externally rotate arm against even minimal resistance
Drop arm test is positive
Local swelling
Gradual and progressive pain, worse at night
Pain localizes to lateral aspect of upper arm
Arm elevation, external rotation, and lifting objects worsens the pain
Disuse atrophy may be present in chronic<unk> s
TTP lateral aspect of upper arm or in subacromial region
Supraspinatus Test (+ LR 3.2)
Abduct arm to 90', forward flex it 30' with thumb down ("empty beer can position")
Test for pain/weakness against resistance to continued abduction
Infraspinatus and Teres Minor Test
Stabilize the elbow against the patient's waist and bend the elbow to 90'
Test for pain/weakness against resistance to external rotation
External rotation lag sign - more specific to teres minor, given overlap between infraspinatus and teres minor
Support the arm to 20-30 degrees in scapular plane, externally rotated, elbow flexed to 90 degrees
Positive test is pain or difficulty in keeping the arm from internally rotating when clinician lets go
Subscapularis (+ LR 1.9)
Place hand behind lower back
Test for pain/weakness as patient attempts to push examiner's hand away by moving dorsum of hand away from back
Drop arm test
Patient is unable to hold or smoothly lower an extended arm at 90' of shoulder abduction with out dropping it
Abduct arm to 90', forward flex it 30' with thumb down ("empty beer can position")
Test for pain/weakness against resistance to continued abduction
Stabilize the elbow against the patient's waist and bend the elbow to 90'
Test for pain/weakness against resistance to external rotation
Support the arm to 20-30 degrees in scapular plane, externally rotated, elbow flexed to 90 degrees
Positive test is pain or difficulty in keeping the arm from internally rotating when clinician lets go
Place hand behind lower back
Test for pain/weakness as patient attempts to push examiner's hand away by moving dorsum of hand away from back
Patient is unable to hold or smoothly lower an extended arm at 90' of shoulder abduction with out dropping it
Rotator cuff tear
Traumatic/Acute:
Biceps tendinitis
Shoulder Dislocation
Medial epicondylitis
Anterior shoulder dislocation
Biceps tendon rupture
Posterior shoulder dislocation