Rotator cuff tear infraspinatus, teres minor, and subscapularis, may also be injured. The amount of stress needed to tear a rotator cuff tendon acutely will depend on the underlying condition of the tendon prior to the stress. In the case of a healthy tendon, the stress needed will be high, such as a fall on the outstretched arm. This stress may occur coincidentally with other injuries such as a dislocation of the shoulder, or separation of the acromioclavicular joint. In the case of a tendon with pre-existing degeneration, the force may be surprisingly modest, such as a sudden lift, particularly with the arm
Rotator cuff tear single physical examination test distinguishes reliably between bursitis, partial-thickness, and full-thickness tears. On the contrary, a combination of tests seems to provide the most accurate diagnosis. For impingement, these tests include the Hawkins-Kennedy impingement sign in which the examiner medially rotates the patient's flexed arm, forcing the supraspinatus tendon against the coracoacromial ligament and so producing pain if the test is positive a positive painful arc sign, and weakness in external rotation with the arm at the side. For the diagnosis of full-thickness rotator cuff tear, the best combination appears to include once more the painful arc and weakness in