Rotator Cuff Muscle Examination - Everything You Need To Know - Dr. Nabil Ebraheim

Dr. Ebraheim's animated educational video describing testing of the rotator cuff muscles.
A rotator cuff is a group of four muscles:
1-Supraspinatus
2-Infraspinatus
3-Teres minor
4-Subscapularis
Each muscle has its own function. These function s can overlap with muscles in this group or with other muscles.
Shoulder abduction can come from the supraspinatus, infraspinatus or the deltoid muscles.
External rotation of the shoulder can come from the infraspinatus muscle or the teres minor muscles. External rotation with the arm at the side. External rotation of the shoulder occurs in conjunction with the teres minor.
Internal rotation of the shoulder can come from the teres major, latissimus dorsi, the subscapularis and the pectoralis major.
These rotator cuff muscles are commonly injured or affected. Diagnose which rotator cuff muscle is affected by the injury or by the pathology. Each muscle has to be isolated and tested.
Supraspinatus muscle
Jobes test/Empty can
The best test for examination of the supraspinatus muscle is the Jobes test or Empty Can Test. The patient is standing or sitting upright. The arm should be anteriorly flexed at the level of the shoulder. The patient will fully pronate the arm into the empty can position with the thumb pointing downward. The patient should resist the downward force being applied on the forearm by the examiner. Pain or weakness indicated a supraspinatus tendon lesion.
Infraspinatus muscle: strong external rotator of the shoulder with the arm to the side. The infraspinatus muscle is usually tested by testing the external rotation of the shoulder with the arm to the side. Testing external rotation of the arm against resistance.
External rotation lag test: the examiner passively rotates the arm into full external rotation. Positive test when the examiner lets go of the arm and the patient is unable to maintain the position of full external rotation.
Teres minor muscle
Horn blower’s test: external rotation is tested with the arm held in 90 degrees of abduction. Positive test if the arm falls into internal rotation.
The subscapularis is an internal rotator of the shoulder. There are several tests for the subscapularis muscle.
Belly-press test: the patient is standing with the hand of the affected arm resting against the stomach with the elbow anterior to the midaxillary line. The patient is then asked to press the belly against the affected arm without moving the elbow. Failure to maintain the elbow anterior to the midaxillary line while pressing against the belly indicates predominantly a subscapularis tendon tear.
Bear-hug test: the patient is asked to place the palm of the hand onto the opposite shoulder with the elbow anterior to the body. The patient will maintain the internal rotation of the shoulder in this position and the examiner will then attempt to externally rotate the arm. A positive test will result when the patient shows weakness of the arm compared to the opposite arm.
Both of these test the upper subscapularis.
The lift-off test is a good test for the lower subscapularis muscle. The patient is standing with affected arm internally rotated behind the back so the dorsum of the hand will be resting on the lumbar area. The examiner will passively lift the arm away from the patient’s back. Once the examiner releases the arm, failure to maintain the position of the arm away from the back will indicate a subscapularis tendon tear.

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