Rotator cuff tear vs Adhesive capsulitis and impingement
How to tell Rotator cuff tear and Adhesive capsulitis and impingement apart when a board question makes them look alike.
Tear is weakness with active motion; adhesive capsulitis loses active and passive ROM; impingement is painful arc with preserved strength.
Side by side
Rotator cuff tear causes weakness with active abduction or external rotation, painful arc, positive drop-arm test, and preserved passive range early.
Adhesive capsulitis causes global loss of active and passive range; impingement causes painful arc from tendon compression with strength usually preserved.
Tendon tear disrupts supraspinatus or other cuff force transmission.
Capsular fibrosis restricts motion in adhesive capsulitis; subacromial narrowing irritates cuff tendons in impingement.
Positive drop-arm test or MRI tendon defect supports rotator cuff tear.
Passive ROM loss supports adhesive capsulitis; Neer/Hawkins impingement signs support impingement.
The trap
Shoulder pain overlaps, so active versus passive range and true weakness separate causes.
The repair move
For shoulder pain, decide in three steps: (1) compare ACTIVE versus PASSIVE range of motion loss of BOTH active and passive ROM equals adhesive capsulitis (frozen shoulder, more common in diabetic women aged 40 to 60 and after immobilization; treat with PT, intra-articular corticosteroid, hydrodilatation, or manipulation under anesthesia if refractory); (2) test STRENGTH true weakness with positive drop-arm test equals rotator cuff tear (supraspinatus is most commonly torn; confirm with MRI; surgical repair if full-thickness in young or active patients, conservative management otherwise); (3) painful arc (60 to 120 degrees of abduction) with preserved strength and positive Neer and Hawkins tests equals subacromial impingement (treat with PT, NSAIDs, and subacromial corticosteroid injection).
Try a free question
CoreA 58-year-old construction worker has 6 weeks of right shoulder pain and weakness after a fall onto an outstretched arm. He cannot lift his arm above his head, but a clinician can passively elevate his arm to almost full range. The drop arm test is positive. MRI shows a full-thickness tear of the supraspinatus tendon. Which diagnosis is most likely?
Show answer and explanation
Answer: A. Rotator cuff tear. Rotator cuff tear presents with weakness on ACTIVE motion but relatively preserved PASSIVE range of motion; supraspinatus is the most commonly torn tendon; treatment options are physical therapy or surgical repair depending on age, function, and tear size.
Why the other choices are tempting
- B. Adhesive capsulitis (frozen shoulder) has loss of BOTH active and passive range of motion.
- C. Subacromial impingement has painful arc between 60-120 degrees of abduction with preserved strength.
- D. Glenohumeral OA shows joint-space narrowing on x-ray with crepitus and chronic pain.
- E. Cervical radiculopathy has dermatomal sensory and motor findings, not isolated shoulder mechanics.
Flashcards
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What test supports rotator cuff tear?
A positive drop-arm test supports rotator cuff tear.
What ROM pattern supports adhesive capsulitis?
Loss of both active and passive ROM supports adhesive capsulitis.
Quick answers
What is the fastest way to tell Rotator cuff tear from Adhesive capsulitis and impingement?
Tear is weakness with active motion; adhesive capsulitis loses active and passive ROM; impingement is painful arc with preserved strength.
What is the key clue for Rotator cuff tear?
Rotator cuff tear causes weakness with active abduction or external rotation, painful arc, positive drop-arm test, and preserved passive range early.
What is the key clue for Adhesive capsulitis and impingement?
Adhesive capsulitis causes global loss of active and passive range; impingement causes painful arc from tendon compression with strength usually preserved.
What is the common trap with Rotator cuff tear vs Adhesive capsulitis and impingement?
Shoulder pain overlaps, so active versus passive range and true weakness separate causes.