<h3>Research Objectives</h3> To assess the sensitivity, specificity, and accuracy of selected physical examination procedures in identifying supraspinatus tears using magnetic resonance imaging (MRI) as a reference criteria in wheelchair users with chronic paraplegia. <h3>Design</h3> Cross-sectional. <h3>Setting</h3> Three SCI Model Systems (SCIMS) Centers. <h3>Participants</h3> 62 full-time manual wheelchair users with chronic paraplegia (104 shoulders; average age 41.1±11.7; average injury duration 12.5±9.9; average BMI 25.4±9.9; 19.4% female). <h3>Interventions</h3> N/A. <h3>Main Outcome Measures</h3> Presence or absence of supraspinatus tears, diagnosed by MRI[1]; physical examinations for supraspinatus pathology, including supraspinatus palpation over the greater tuberosity[2], painful arc[3], Neer's test[4], Jobe's test[5], and resisted external rotation (ER); diagnostic statistics including sensitivity, specificity, positive and negative likelihood ratios, positive and negative predictive values. A receiver operating characteristic (ROC) curve was generated to determine the area under the curve [AUC]. <h3>Results</h3> A positive Jobe's test, greater tuberosity palpation, and resisted ER produced the highest positive likelihood ratios (between 3.0 and 4.1), yet sensitivities were low (0.33-0.50). The ROC curve suggested the optimal threshold to detect a supraspinatus tear was one or more of the following positive tests: Jobe's, tendon palpation, ER, painful arc (sensitivity=0.67, specificity=0.074). The ROC curve with these four tests yielded an AUC of 0.72. When Neer's was included, the AUC was 0.70. <h3>Conclusions</h3> The findings from this study indicate no single test was best to screen for supraspinatus tears in this sample. Presence of one or more positive physical examination tests yielded the best accuracy. The low prevalence of tears among this sample could have negatively affect the power to determine sensitivity. Future studies should aim to include a larger proportion of individuals with tears to better determine sensitivity of the tests. <h3>Author(s) Disclosures</h3> The authors have nothing to disclose.