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Rotator Cuff Tear Cheat Sheet (DRAFT) by

Management of rotator cuff tear/tendinopathy.

This is a draft cheat sheet. It is a work in progress and is not finished yet.


Majority occur in the rotator crescent
Rotator cable takes load majority, allowing the RC muscles to still function and keep humeral head in place
A tear in the ant. cable creates a larger gap, increases cuff strain, and loses its stress shielding capabi­lities
Mostly supras­pinatus tendon
If the tear enlarges (which it may not), only a minority enlarge >5mm in 3 years


Clinically important change (reported by pt) in 12 weeks
Up to 4-6 months (more severe cases)

Special Popula­tions to Consider

Tear freque­ntly, do not respond well to treatment
Suscep­tible to develop muscle aches, tenderness and stiffness
Metabolic syndrome
Cluster of conditions that increase risk of diabetes


Older sports person with shoulder pain during activity.
<40 generally trauma
>60 generally degene­rative
40<­x>60 either trauma or degene­rative

Risk Factors for Progre­ssion

Tear size
1-tendon tears may remain dormant while 2-tendon lesions are more likely to undergo structural deteri­oration
Ant. RC cable tears have sig greater tear migration, decreased tendon stiffness, and increased regional tendon strain


up to 1cm
1-3 cm
3-5 cm

Clinical Presen­tation

Pain with overhead activity (throwing, swimming, overhead shots with racket). <90 degrees usually pain free.
Pain may present with abduction (painful arc) or IR behind back
Scapular muscle weakness and dysfun­ction, tightness of the posterior capsule and other soft tissues and postural abnorm­alities

Subjective Markers

MOI: Falling on outstr­etched hand, unexpected pushing or pulling, or during shoulder disloc­ation.
Night pain.
History of associated symptoms of instab­ility (ex. recurrent sublux­ation or episodes of "dead arm")

Objective Assessment

Muscle atrophy (infra­spi­natus may also mean supras­capular nerve injury)
Tenderness over supras­pinatus tendon to or at its insertion into the greater tuberosity of the humerus.
Painful arc btwn 70-120deg (AROM). IR reduced.
IR, ER (infra­spi­natus), and abd. (supra­spi­natus) may be reduced. Measure with the scapula accurately stabil­ized.
Functional Tests
throwing overhead


Exercise > over no treatment or placebo and did not differ in outcomes compared to surgery or multi-­modal physio (Littl­ewood et al)
Improving scapular stability, neurom­uscular control of shoulder girdle and thoracic posture, "­loo­sen­" tight muscles
Address altered shoulder complex kinematics (decreased SA strength, hypera­ctivity and early activity of upper traps, decreased activity and late activa­tions of middle and lower traps)
Examples: "low row", "­law­nmo­ver­", "­rob­ber­y" - stabil­izing but not stressing GHJ
Streng­thening middle­/lower traps, and RC muscles (starting w low load), ant. delt., and teres minor
Exercise plan (Edwards, Ebert, Joss, Bhabra et al. 2016)

Special Tests

Lift off, Belly Press, Belly-off sign, Bear Hug Test
Supras­pinatus and Infras­pinatus
External rotation lag sign, Jobe's, Drop arm test, Neer
Teres minor
Hornbl­ower's sign