Clinical inquiries. What is the best way to diagnose a suspected rotator cuff tear?
The evaluation of a suspected rotator cuff tear should start with a history and a clinical exam of the shoulder (strength of recommendation [SOR]: B, based on a systematic review of cohort studies). Three clinical test results in particular--supraspinatus weakness, weakness of external rotation, and impingement--or 2 positive tests for a patient older than 60 years were highly predictive of rotator cuff tear (SOR: B, based on individual prospective study). Either magnetic resonance imaging (MRI) or ultrasound can confirm a possible full-thickness tear (SOR: B, based on a systematic review of cohort studies). If a patient has an implantable device prohibiting MRI imaging, conventional arthrography is an alternative (SOR: A, individual randomized controlled trial). Suspected partial-thickness tears are best verified with an ultrasound (SOR: B, based on a systematic review of cohort studies).
Diehr
Sabina
S
Medical College of Wisconsin, Milwaukee, WI, USA.
Ison
David
D
Jamieson
Barbara
B
Oh
Robert
R
D006801:Humans; D008279:Magnetic Resonance Imaging; D010808:Physical Examination; D011237:Predictive Value of Tests; D000070636:Rotator Cuff Injuries; D013708:Tendon Injuries / Q000175:diagnosis*; D014463:Ultrasonography