Rotator Cuff Defect: Acute or Chronic?

Abstract

THE PATIENT A 63-year-old, right hand–dominant man presents with a 3-week history of right shoulder pain after trying to catch a suitcase falling out of an overhead bin on an airplane. He has had no antecedent pain or weakness and no history of prior shoulder injury. Examination demonstrates pain limiting active and forward flexion to 140°, internal rotation to the buttock, and external rotation to 50°. The patient has positive Neer and Hawkins impingement tests. External rotation strength is preserved and there is no external rotation lag. He has no cervical radicular symptoms, and minimal biceps and acromioclavicular joint symptoms. After injection of lidocaine into the subacromial space, the patient is able to forward flex the shoulder to 170°, internally rotate to T10, and externally rotate to 70°, which is symmetric with the opposite arm. Magnetic resonance imaging ordered by his primary care doctor demonstrates a full-thickness tear of the supraspinatus tendon, 10 mm in anteroposterior dimension with 5 mm of retraction.