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Rotator cuff tears
The rotator cuff stabilises the humeral head and allows elevation and rotation of the arm; a degenerative tear in an older patient is usually treated first with physiotherapy, while an acute traumatic tear in an active patient, or sudden weakness after a shoulder dislocation in an older adult, calls for early imaging and consideration of repair.
Why it matters in the exam
Questions present shoulder pain over the lateral arm, worse with overhead activity and lying on the shoulder at night, and ask which tendon is involved and how to treat it. The tendon most often torn is supraspinatus. A painful arc of elevation between 60 and 120 degrees is typical of impingement or tendon injury, and the Neer and Hawkins tests support it. The Jobe (empty can) test checks supraspinatus, weakness of external rotation checks infraspinatus, and the lift-off and belly press tests check subscapularis. The key distinction is between frozen shoulder, in which passive movement is also restricted, especially external rotation, and a cuff tear, in which passive movement is preserved and the weakness is in active movement. Ultrasound or MRI confirms the tear. The treatment decision: a degenerative tear in an older patient is treated first with physiotherapy, analgesia and sometimes an injection, and surgery is considered when there is no improvement; an acute traumatic tear in an active patient is repaired early, ideally within weeks, before the tendon retracts and the muscle undergoes fatty degeneration. An adult older than 40 who cannot lift the arm after a shoulder dislocation is suspected of a cuff tear or axillary nerve injury. A massive irreparable tear with joint wear (cuff tear arthropathy) is treated with reverse shoulder replacement.
Key points
- Supraspinatus is the tendon most often torn.
- Painful arc 60–120 degrees and weak elevation.
- Passive movement preserved — tear; restricted — frozen shoulder.
- Degenerative in an older patient — physiotherapy; acute traumatic in an active patient — early repair.
- Massive tear with wear — reverse shoulder replacement.
Summary table
| Tendon or condition | Function | Clinical test | Note |
|---|---|---|---|
| Supraspinatus | Initial abduction | Jobe (empty can) test | The tendon most often torn |
| Infraspinatus and teres minor | External rotation | Weakness or lag in external rotation | Large tears extend backward |
| Subscapularis | Internal rotation | Lift-off and belly press tests | Sometimes injured after dislocation or trauma |
| Impingement | — | Painful arc 60–120 degrees, Neer and Hawkins | Conservative care and physiotherapy |
| Frozen shoulder | — | Passive and active restriction, mainly in external rotation | Important differential; the tendon is intact |
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Sources
- AAOS Clinical Practice Guideline, 2019 — Management of Rotator Cuff Injuries
- Rockwood and Matsen's The Shoulder, 5th ed. (2017) — Rotator Cuff
- Campbell's Operative Orthopaedics, 14th ed. (2021) — Shoulder and Elbow Injuries
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.