Snapshot A 50-year-old woman reports shoulder pain that has worsened over the past year. She states that she has difficulty sleeping at night on the right side and experiences significant pain in the right arm when reaching over her head. On physical exam, the empty can test is positive. She is referred for physical therapy and given ibuprofen for pain management. Introduction Clinical definition injury to one or more of the rotator cuff muscles injury is typically due to tear or tendinopathy rotator cuff muscles, which are all innervated by C5 and C6, are the SITS login to view 20 more bullets Epidemiology incidence the supraspinatus muscle is most commonly injured demographics adults risk factors older age smoking repetitive overhead reaching Pathogenesis acute avulsion injuries typically following trauma chronic degenerative tears repetitive overhead motions tendon weakening due to degenerative changes and chronic impingement Associated conditions biceps tendinopathy osteoarthritis Prognosis re-tear may occur Presentation Symptoms shoulder pain exacerbated by login to view 2 more bullets limited function of the shoulder Physical exam severe focal tenderness at the insertion of supraspinatus (anterolateral shoulder) decreased active elevation with normal passive range of motion Hawkins impingement test passive internal rotation of the shoulder with the patient seated and elbow flexed 90° test is positive if there is pain Neer impingement test passive elevation of the arm while internally rotated with the patient standing test is positive if there is pain painful arc sign pain with active abduction between 60° and 120° empty can test patient with arm elevated to 90° with elbow extended and thumbs down login to view 1 more bullet test is positive if there is pain 90% specificity for supraspinatous pathology Imaging Radiographs indication for all patients as initial imaging finding loss of subacromial space, due to upward migration of humeral head Magnetic resonance imaging (MRI) indications if radiography is normal but there is suspicions for rotator cuff injury not indicated for all patients most accurate test Studies Making the diagnosis most cases are clinically diagnosed Differential Adhesive capsulitis distinguishing factor active and passive range of motion are limited Treatment Conservative physical therapy indication login to view 1 more bullet Medical nonsteroidal anti-inflammatory drugs (NSAIDs) indications login to view 2 more bullets steroid injections indication login to view 1 more bullet Operative surgical repair indications login to view 2 more bullets Complications Functional limitations Adhesive capsulitis