Journal of Shoulder and Elbow Surgery

Supraspinatus tears: predictability of magnetic resonance imaging findings based on clinical examination

Published:March 03, 2021DOI:


      The shoulder physical examination is frequently performed to diagnose rotator cuff tears in clinical practice; however, there is insufficient evidence on which physical tests are efficient for shoulder impingements in primary care settings. The purposes of this study were (1) to analyze the accuracy of 8 clinical tests to diagnose supraspinatus tendon lesions and investigate whether the combination of these tests can improve the diagnostic values; (2) to assess which are the best positivity criteria for shoulder maneuvers—pain and/or weakness; and (3) to investigate the ability of these tests to distinguish between partial- and full-thickness tears.


      A total of 733 consecutive patients were prospectively evaluated by 4 shoulder surgeons in this multicenter diagnostic study from May 2017 to December 2018, and 8 clinical tests (empty-can, full-can test, drop arm, painful arc, Neer sign, Hawkins test, Patte test, and resisted external rotation) were compared with magnetic resonance imaging performed by blinded radiologists. We assessed the sensitivity, specificity, accuracy, positive and negative predictive values, and diagnostic odds ratio (DOR) for all tests.


      For overall supraspinatus tears, the empty-can test showed the highest sensitivity (0.81), the Patte test (positive for pain and weakness) and the drop-arm test showed the highest specificity (0.99 and 0.98, respectively), and the best combination was the Neer sign and the drop-arm test (DOR, 12.92). The positivity criteria for pain associated with weakness showed the highest performance, with DORs of 16.94 for the Patte test and 10.45 for the empty-can test. The Patte test and resisted external rotation, positive for pain and weakness, showed the highest ability to distinguish between full- and partial-thickness tears (DOR, 5.69 and 5.35, respectively). The shoulder maneuvers showed low negative predictive values; the highest value (0.58) was found with the empty-can test.


      (1) The clinical tests demonstrated excellent diagnostic values; the empty-can test had the highest sensitivity, whereas the drop-arm test and the Patte test had the highest specificity; and the best combination for detecting supraspinatus tears was the Neer sign and the drop-arm test. On the other hand, the physical examination findings showed limited values to rule out tears. (2) The best positivity criterion for shoulder maneuvers was pain associated with weakness. (3) The Patte test and resisted external rotation showed the highest ability to distinguish between full- and partial-thickness tears.

      Level of evidence


      To read this article in full you will need to make a payment


      Subscribe to Journal of Shoulder and Elbow Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Bateman J.E.
        The diagnosis and treatment of ruptures of the rotator cuff.
        Surg Clin North Am. 1963; 43: 1523-1530
        • Cadogan A.
        • McNair P.
        • Laslett M.
        • Hing W.
        Shoulder pain in primary care: diagnostic accuracy of clinical examination tests for non-traumatic acromioclavicular joint pain.
        BMC Musculoskelet Disord. 2013; 14: 156
        • Chauhan N.S.
        • Ahluwalia A.
        • Sharma Y.P.
        • Thakur L.
        A prospective comparative study of high resolution ultrasound and MRI in the diagnosis of rotator cuff tears in a tertiary hospital of North India.
        Pol J Radiol. 2016; 81: 491-497
        • Codman E.
        Ruptures of the supraspinatus tendon and other lesions in or about the subacromial bursa.
        in: The shoulder. Boston, MA, T. Todd Company1934
        • Collin P.
        • Treseder T.
        • Denard P.J.
        • Neyton L.
        • Walch G.
        • Lädermann A.
        What is the best clinical test for assessment of the teres minor in massive rotator cuff tears?.
        Clin Orthop Relat Res. 2015; 473: 2959-2966
        • Gismervik S.
        • Drogset J.O.
        • Granviken F.
        • Rø M.
        • Leivseth G.
        Physical examination tests of the shoulder: a systematic review and meta-analysis of diagnostic test performance.
        BMC Musculoskelet Disord. 2017; 18: 41
        • Glas A.S.
        • Lijmer J.G.
        • Prins M.H.
        • Bonsel G.J.
        • Bossuyt P.M.M.
        The diagnostic odds ratio: a single indicator of test performance.
        J Clin Epidemiol. 2003; 56: 1129-1135
        • Hajian-Tilaki K.
        Sample size estimation in diagnostic test studies of biomedical informatics.
        J Biomed Inform. 2014; 48: 193-204
        • Hanchard N.C.A.
        • Lenza M.
        • Handoll H.H.G.
        • Takwoingi Y.
        Physical tests for shoulder impingements and local lesions of bursa, tendon or labrum that may accompany impingement.
        Cochrane Database Syst Rev. 2013; 2013: CD007427
        • Hawkins R.J.
        • Kennedy J.C.
        Impingement syndrome in athletes.
        Am J Sports Med. 1980; 8: 151-158
        • Hermans J.
        • Luime J.J.
        • Meuffels D.E.
        • Reijman M.
        • Simel D.L.
        • Bierma-Zeinstra S.M.A.
        Does this patient with shoulder pain have rotator cuff disease?.
        JAMA. 2013; 310: 837-847
        • Holtby R.
        • Razmjou H.
        Validity of the supraspinatus, test as a single clinical test in diagnosing patients with rotator cuff pathology.
        J Orthop Sports Phys Ther. 2004; 34: 194-200
        • Itoi E.
        • Kido T.
        • Sano A.
        • Urayama M.
        • Sato K.
        Which is more useful the “full can test” or the “empty can test,” in detecting the torn supraspinatus tendon?.
        Am J Sports Med. 1999; 27: 65-68
        • Jain N.B.
        • Fan R.
        • Higgins L.D.
        • Kuhn J.E.
        • Ayers G.D.
        Does my patient with shoulder pain have a rotator cuff tear? A predictive model from the ROW Cohort.
        Orthop J Sports Med. 2018; 6
        • Jain N.B.
        • Luz J.
        • Higgins L.D.
        • Dong Y.
        • Warner J.J.P.
        • Matzkin E.
        • et al.
        The diagnostic accuracy of special tests for rotator cuff tear: the ROW Cohort Study.
        Am J Phys Med Rehabil. 2017; 96: 176-183
        • Jobe F.W.
        • Jobe C.M.
        Painful athletic injuries of the shoulder.
        Clin Orthop Relat Res. 1983; 173: 117-124
        • Jobe F.W.
        • Moynes D.R.
        Delineation of diagnostic criteria and a rehabilitation program for rotator cuff injuries.
        Am J Sports Med. 1982; 10: 336-339
        • Kelly B.T.
        • Kadrmas W.R.
        • Speer K.P.
        The manual muscle examination for rotator cuff strength: an electromyographic investigation.
        Am J Sports Med. 1996; 24: 581-588
        • Kessel L.
        • Watson M.
        The painful arc syndrome. Clinical classification as a guide to management.
        J Bone Joint Surg Br. 1977; 59: 166-172
        • Kibler W.B.
        • Sciascia A.
        • Dome D.
        Evaluation of apparent and absolute supraspinatus strength in patients with shoulder injury using the scapular retraction test.
        Am J Sports Med. 2006; 34: 1643-1647
        • Korevaar D.A.
        • Cohen J.F.
        • Reitsma J.B.
        • Bruns D.E.
        • Gatsonis C.A.
        • Glasziou P.P.
        • et al.
        Updating standards for reporting diagnostic accuracy: the development of STARD 2015.
        Res Integr Peer Rev. 2016; 1: 7
        • Lasbleiz S.
        • Quintero N.
        • Ea K.
        • Petrover D.
        • Aout M.
        • Laredo J.D.
        • et al.
        Diagnostic value of clinical tests for degenerative rotator cuff disease in medical practice.
        Ann Phys Rehabil Med. 2014; 57: 228-243
        • Lenza M.
        • Buchbinder R.
        • Takwoingi Y.
        • Johnston R.V.
        • Hanchard N.C.A.
        • Faloppa F.
        Magnetic resonance imaging, magnetic resonance arthrography and ultrasonography for assessing rotator cuff tears in people with shoulder pain for whom surgery is being considered.
        Cochrane Database Syst Rev. 2013; 2013: CD009020
        • Liu F.
        • Cheng X.
        • Dong J.
        • Zhou D.
        • Han S.
        • Yang Y.
        Comparison of MRI and MRA for the diagnosis of rotator cuff tears: a meta-analysis.
        Medicine (Baltimore). 2020; 99: e19579
        • Liu J.
        • Hughes R.E.
        • Smutz W.P.
        • Niebur G.
        • Nan-An K.
        Roles of deltoid and rotator cuff muscles in shoulder elevation.
        Clin Biomech (Bristol, Avon). 1997; 12: 32-38
        • Minagawa H.
        • Yamamoto N.
        • Abe H.
        • Fukuda M.
        • Seki N.
        • Kikuchi K.
        • et al.
        Prevalence of symptomatic and asymptomatic rotator cuff tears in the general population: from mass-screening in one village.
        J Orthop. 2013; 10: 8-12
        • Neer C.S.
        Impingement lesions.
        Clin Orthop Relat Res. 1983; 173: 70-77
        • Park H.B.
        • Yokota A.
        • Gill H.S.
        • El Rassi G.
        • McFarland E.G.
        Diagnostic accuracy of clinical tests for the different degrees of subacromial impingement syndrome.
        J Bone Joint Surg Am. 2005; 87: 1446-1455
        • Roy J.S.
        • Braën C.
        • Leblond J.
        • Desmeules F.
        • Dionne C.E.
        • MacDermid J.C.
        • et al.
        Diagnostic accuracy of ultrasonography, MRI and MR arthrography in the characterisation of rotator cuff disorders: a systematic review and meta-analysis.
        Br J Sports Med. 2015; 49: 1316-1328
        • Sgroi M.
        • Loitsch T.
        • Reichel H.
        • Kappe T.
        Diagnostic value of clinical tests for supraspinatus tendon tears.
        Arthroscopy. 2018; 34: 2326-2333
        • Somerville L.E.
        • Willits K.
        • Johnson A.M.
        • Litchfield R.
        • Lebel M.E.
        • Moro J.
        • et al.
        Clinical assessment of physical examination maneuvers for rotator cuff lesions.
        Am J Sports Med. 2014; 42: 1911-1919
        • Tennent T.D.
        • Beach W.R.
        • Meyers J.F.
        A review of the special tests associated part I: the rotator cuff tests.
        Am J Sports Med. 2003; 31: 154-160
        • Villafañe J.H.
        • Valdes K.
        • Anselmi F.
        • Pirali C.
        • Negrini S.
        The diagnostic accuracy of five tests for diagnosing partial-thickness tears of the supraspinatus tendon: a cohort study.
        J Hand Ther. 2015; 28: 247-251
        • Vind M.
        • Bogh S.B.
        • Larsen C.M.
        • Knudsen H.K.
        • Sogaard K.
        • Juul-Kristensen B.
        Inter-examiner reproducibility of clinical tests and criteria used to identify subacromial impingement syndrome.
        BMJ Open. 2011; 1: e000042