FPIN's Help Desk Answers

Rotator Cuff Disease: Diagnostic Tests


Am Fam Physician. 2016 Dec 1;94(11):925-926.

Clinical Question

Which physical examination tests are best for diagnosing rotator cuff disease in patients with shoulder pain?

Evidence-Based Answer

A positive lag sign with external rotation is the best test for full-thickness tears of the infraspinatus and supraspinatus (positive likelihood ratio = 7.2). A positive lag sign with internal rotation is best for assessing full-thickness tears of the subscapularis (positive likelihood ratio = 5.6). (Strength of Recommendation = B, based on diagnostic cohort studies.)

Evidence Summary

A meta-analysis of five diagnostic cohort studies (432 men and women, 442 shoulders) evaluated physical examination tests for rotator cuff disease.1 Patients had a mean age of 44 to 58 years and a presenting symptom of shoulder pain; exclusion criteria included a history of neck or shoulder trauma. The prevalence of rotator cuff disease ranged from 33% to 81%, depending on the study. The diagnostic standard was ultrasonography or magnetic resonance imaging. Five strength tests used weakness as the response criterion for a positive result. A positive external rotation lag test was the most accurate strength test for identifying full-thickness tears of the

Address correspondence to Christian Verry, MD, at christian.verry@mercy.net. Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.


1. Hermans J, Luime JJ, Meuffels DE, Reijman M, Simel DL, Bierma-Zeinstra SM. Does this patient with shoulder pain have rotator cuff disease? The rational clinical examination systematic review. JAMA. 2013;310(8):837–847.

2. Lasbleiz S, Quintero N, Ea K, et al. Diagnostic value of clinical tests for degenerative rotator cuff disease in medical practice. Ann Phys Rehabil Med. 2014;57(4):228–243.

Help Desk Answers provides answers to questions submitted by practicing family physicians to the Family Physicians Inquiries Network (FPIN). Members of the network select questions based on their relevance to family medicine. Answers are drawn from an approved set of evidence-based resources and undergo peer review. The strength of recommendations and the level of evidence for individual studies are rated using criteria developed by the Evidence-Based Medicine Working Group (http://www.cebm.net/?o=1025).

The complete database of evidence-based questions and answers is copyrighted by FPIN. If interested in submitting questions or writing answers for this series, go to http://www.fpin.org or e-mail: questions@fpin.org.

This series is coordinated by John E. Delzell Jr., MD, MSPH, Assistant Medical Editor.


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