Your doctor will have you perform a range of movements to help determine whether you have a torn rotator cuff.

Your rotator cuff is a group of four muscles that stabilizes the ball and socket of your shoulder joint. These muscles are often referred to as the SITS muscles, which stands for:

A rotator cuff tear occurs when you have a tear in the body or tendon of one of these muscles.

Injuries to the rotator cuff are the most common tendon injuries treated in adults. More than 4.5 million people seek medical attention each year in the United States for rotator cuff pain. About 30 percent of adults over the age of 60 have a rotator cuff tear and this number rises to 62 percent by age 80.

Let’s examine the tests that doctors and physiotherapists often used to diagnose torn rotator cuffs. We’ll also break down treatment options.

A doctor or physiotherapist can use one of more than 25 functional tests during a physical exam to diagnosis a torn rotator cuff. Some of these tests directly indicate a rotator cuff injury and others rule out similar injuries like nerve impingement or torn labrum.

In some cases, a doctor may also recommend imagining tests to diagnose a torn rotator cuff.

Apley scratch test

How it’s performed: You will reach one hand behind your back and the other over your shoulder.

What it tests for: Rotator cuff injuries or limited range of motion

Positive result: Pain or limitation on the injured side compared to the uninjured side

Hornblower’s sign test

How it’s performed: A doctor will raise your arm to your side and bend your elbow to 90 degrees. You will then externally rotate your arm as the doctor resists.

What it tests for: Damage to the teres minor rotator cuff muscle

Positive result: An inability to externally rotate

Bear hug test

How it’s performed: You’ll put the hand of your injured arm on your opposite shoulder. A doctor will then try to pull your hand off your shoulder while you resist.

What it tests for: Damage to subscapularis rotator cuff muscle

Positive result: Weakness or pain in your shoulder

Neer’s sign

How it’s performed: A doctor will stabilize your scapula, rotate your arm internally, and flex your arm.

What it tests for: Shoulder impingement

Positive result: Pain while lifting arm

Hawkins’ test

How it’s performed: Your arm will be flexed forward by a doctor and then bent at the elbow 90 degrees. They will then rotate it across your body.

What it tests for: Shoulder impingement

Positive result: Pain when your arm is internally rotated

Drop-arm test

How it’s performed: You will raise your arms to the side as high as possible and lower them to 90 degrees.

What it tests for: Torn rotator cuff

Positive result: An inability to hold your arms at 90 degrees because of pain

Cross-arm test

How it’s performed: Your arm will be lifted straight and in front of you and brought across your body.

What it tests: Arthritis of your acromioclavicular joint

Positive result: Pain where your scapula and collar bone meet

Spurling’s test

How it’s performed: You will look toward your painful shoulder and a doctor will apply a light pressure to the front of your head with their hand.

What it tests for: Cervical nerve root disorder

Positive result: Pain in your shoulder or arm

Apprehension test

How it’s performed: Your arm will be lifted to your side with your elbow bent at 90 degrees. A doctor will rotate your hand behind you while stabilizing your shoulder.

If the apprehension test is performed while lying down and is positive, the relocation test is then conducted by applying down pressure over the shoulder. This stabilizes the shoulder. If it provides relief, this is a positive test and further supports the diagnosis of shoulder instability.

What it tests for: Instability in the front part of your shoulder joint

Positive result: Discomfort or pain in the test position

Sulcus sign

How it’s performed: A doctor will stabilize your arm at the shoulder while gently pulling on your arm.

What it tests for: Shoulder instability

Positive result: A greater than normal amount of depression of your shoulder joint

Yergason test

How it’s performed: You’ll flex your arm to 90 degrees and the doctor will shake hands with you while rotating your hand away from your body.

What it tests for: Instability of your shoulder joint or biceps tendonitis

Positive result: Pain along your biceps tendon

Speed’s maneuver

How it’s performed: You’ll flex your arm straight in front of your body with your palm facing upward while a doctor provides resistance.

What it tests: Biceps tendon instability or tendonitis

Positive result: Pain along your biceps tendon

“Clunk” sign

How it’s performed: While you lie on a table, a doctor will rotate your upper arm as they lift your arm over your head.

What it tests: Labral disorders

Positive result: The presence of a clunking sound

Jobe’s test (empty can test)

How it’s performed: You will attempt to lift your arms against a doctor’s resistance with your thumbs facing downward

What it tests: Rotator cuff injury to supraspinatus or infraspinatus muscles

Positive result: Pain or weakness on your injured side

Imaging tests

A doctor might request one of several imaging tests to diagnosis your torn rotator’s cuff such as an x-ray, ultrasound, or magnetic resonance imaging(MRI).

  • X-rays won’t show a torn rotator cuff but can rule out other causes of pain, such as bone spurs.
  • Ultrasounds can be used to monitor the muscle and tendons while you move your arm and compared to your other arm.
  • MRIs use radio waves to create a picture of the bone, muscles, and connective tissue in your shoulder.

Symptoms of a torn rotator cuff muscle can vary depending on which muscle you injure and how severe your injury is. The severity of the injury can vary from microtears to complete tears and can be caused by either a sudden injury or repeated stress over time. Tears from a sudden injury generally cause more intense pain.

Some of the most common symptoms include:

  • pain when lying on your injured shoulder
  • pain when lifting your arm or rotating at the shoulder joint
  • weakness in the injured arm
  • cracking or popping in certain positions

If you suspect you have a torn rotator cuff, it’s a good idea to avoid activities that give you pain and rest your shoulder. A doctor can confirm the diagnosis and recommend the best treatment options.

Non-surgical options

Most rotator cuff tears don’t need surgery to heal. Some non-surgical treatment options include:

Conservative treatment

The most basic form of treatment is to rest the injury. Nonsteroidal anti-inflammatory drugs such as ibuprofen can help reduce swelling and manage pain. A doctor may prescribe a sling in to help you protect your shoulder.


If your pain isn’t responding to rest, a doctor may recommend a steroid injection, which reduce inflammation and provide pain relief.

Physical therapy

Undergoing physical therapy can help you strengthen your shoulder and restore your range of motion. A therapist can give you specific exercises and stretches to help you regain function and prevent re-injury.

Surgical options

Surgery may be needed for more severe rotator cuff injuries. Some surgical options include:

Open repair

During an open repair, a surgeon makes an incision over your shoulder and detaches your deltoid muscles to access the injured rotator cuff muscles. Open repair is the most invasive technique and may be used if there’s extensive damage or if you need a tendon transfer or shoulder replacement.

Tendon transfer

During a tendon transfer, your surgeon will take a tendon from one part of your body and use it to repair the damaged tendon. It may be performed if the tendon is too damage to be reattached.

Mini-open repair

During a mini-open repair, your surgeon will make a smaller incision than they do during full open repair. Your surgeon won’t need to detach your deltoid muscle to access your rotator cuff.

Arthroscopic repair

An arthroscopic repair is the least invasive method. The surgery is performed with a small camera called an arthroscope and very tiny instruments to minimize the recovery time.

Rotator cuff tears are common injuries caused by damage to the muscles or tendons that stabilize your shoulder joint. They can be diagnosed by using a number of physical tests and imaging techniques.