Special tests library › Shoulder & upper arm
Clinical tests for rotator cuff tear, compared
A partial or full-thickness tear of any of the rotator cuff tendons. In the study from which these figures are drawn, most tears involved the supraspinatus, the tendon that crosses the top of the shoulder.
The 7 tests in the library for rotator cuff tear, side by side, each with the published accuracy figures that exist for it. Click a test for what each result means, any caution, and the source.
| Test | Sensitivity | Specificity | LR+ | LR− | Verdict |
|---|---|---|---|---|---|
| Belly-press test | 28% | 87% | 2.2 | 0.83 | A weak test on its own |
| Drop arm test | 24% | 96% | 6.45 | 0.79 | Best used to rule in |
| Empty can / Jobe's test | 88% | 62% | 2.3 | 0.19 | Best used to rule out |
| External rotation lag sign | 10% | 98% | 6.06 | 0.92 | Best used to rule in |
| Full can test | 70% | 81% | 3.75 | 0.37 | A weak test on its own |
| Hornblower's sign | 17% | 96% | 4.81 | not given | A weak test on its own |
| Lateral Jobe test (website only) | 81.4% | 89% | 7.43 | 0.21 | Treat with caution ?Single study by the surgeons who first published the test, in surgical patients of whom 58% had a tear. |
Verdicts: rule in when LR+ is 5 or more; rule out when LR− is below 0.2; both when both; weak when neither; treat with caution where the study behind the figures is weak — tap ? for why.
Reading the table
A high LR+ makes a positive result useful for ruling the condition in; a low LR− makes a negative result useful for ruling it out. A test can be good in one direction and weak in the other, and the figures come from different studies and patient groups, so compare them with care.
Tests for the same problem are rarely independent, so a second positive adds much less than its own figure suggests. Do not multiply their figures together. Where a combination has been tested as a cluster or a decision rule, its published result is given on that cluster’s own page.
To turn a figure into a probability for your patient, use the probability calculator.
Get the book for the shoulder questions that matter: neck or shoulder, a painful cuff or a torn one, and an unstable joint or the labrum
This page gives the published figures. For the tests in it that are in the book, Rule It In, Rule It Out adds how to do each test, what counts as positive, how to read the result, and, where studied, whether combining tests helps.
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