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Table 1 Physical examination tests assessed for acute rotator cuff full-thickness tear in soft tissue shoulder injuries

From: Interrater reliability of physical examination tests in the acute phase of shoulder injuries

Test Scope of test Test method Positive test References
     Test method Test choice
Abduction AROM Supraspinatus muscle or occult injury of greater tuberosity The patient is asked to raise both arms to the side and up. Demonstrated by examiner in the scapular plane (20°- 30° in front of coronal plane), thumbs upwards to minimise pain. Inability to abduct > 90° (derived from the registered no of degrees of abduction) [12] [12, 21]
Painful arc Supraspinatus muscle or occult injury of greater tuberosity (“Impingement”) As over, active test (patient raises the arm) Pain between 60 ° - 120° abduction localised to the deltoid region Kessel and Watson, 1977 [19, 20]
Abduction strength Supraspinatus muscle or occult injury of greater tuberosity Upper arm along side, elbow in 90° flexion, isometric test of abduction strength at 0° and 45° of abduction Strength reduced compared to uninjured side   *
Resisted abduction pain Supraspinatus muscle, occult injury of greater tuberosity Like for abduction strength, but the arm is passively moved to 30°- 40° abduction. If there is no pain by holding the arm in this position, resistance to abduction is applied increasingly (isometric, eccentric). Pain against gravity or isometric resistance. (Negative test: no pain or pain on eccentric resistance)   *
Hawkins` test Supraspinatus muscle or occult injury of greater tuberosity (“Impingement”) The arm is brought to approximately 90° forward flexion, with elbow flexed 90°. The scapula is stabilized with one hand, while the other stabilizes the elbow and internally rotates the shoulder. Pain or marked worsening of existing pain on internal rotation Hawkins, 1980 [19, 20]
External rotation AROM Infraspinatus muscle or occult injury of greater tuberosity The patient stands with back against wall, elbows flexed 90° and held along the side of the body. The patient actively rotates the arm externally while the examiner demonstrates. ≥ 20° difference between sides (derived from registered no of degrees)   @
External rotation strength Infraspinatus muscle or occult injury of greater tuberosity Starting position as over, strength of the patient’s external rotation evaluated with examiner’s hand resisting proximal to the patients wrist Reduced strength compared with uninjured side [12] [12, 23]
Small finger test Infraspinatus muscle or occult injury of greater tuberosity Starting position as over. The examiner stands on the patient’s side and attempts to push with internal rotation force against patient’s wrist using only his or her small finger Cannot resist examiner’s force   #
External rotation lag sign Infraspinatus muscle Elbow flexed 90°. Elbow supported by examiner’s hand and brought to slight elevation (about 20°) in the scapular plane. The examiner’s other hand externally rotates the arm to maximum position, then lets up slightly (about5°). The patient is asked to keep the position when the examiner lets go of the wrist, but still supports the elbow. Unable to hold position [12] [12, 19]
Internal rotation AROM Subscapularis muscle or occult injury of lesser tuberosity Attempt to bring hand behind the body and as high as possible on the back Different level (of four §) compared with uninjured side   
Belly-Press Subscapularis muscle or occult injury of lesser tuberosity Patient exerts pressure on the abdomen with flat hands and with the arm in maximum internal rotation (elbows in front of trunk and straight wrists). May be enforced by the examiner applying external rotation force Cannot hold position or reduced strength compared with uninjured side [22] [22]
Internal rotation lag sign Subscapularis muscle or occult injury of lesser tuberosity Shoulder passively extended and internally rotated to maximum, with elbow flexed 90° Unable to hold position [22] [6, 12, 19]
Internal rotation lag sign anteriorly Subscapularis muscle or occult injury of lesser tuberosity Hands on belly, elbows passively led in front of body until maximum internal rotation in shoulder Unable to hold position   ¤
  1. AROM active range of motion; § 0-plane, gluteal area, lumbar area or inter-scapular area *Strength was assessed in this way, as a large proportion of the patients could not abduct to 90°, and hence normal strength tests like the Dropping sign, Supraspinatus/Empty can/Jobe’s test or the Full can test could not be performed. @ Goniometers are not normally in use in the first line services. This position reduces the risk of misinterpreting the number of degrees due to patient rotating the spine. # Test traditionally used in the hospital, not previously published. ¤ Test included due to some acutely injured patients being unable to perform the belly-press and internal rotation lag sign