Answer to Orthopaedic Question

Question #1 – What are the muscles that make up the rotator cuff?

Answer – Supraspinatus, Infraspinatus, Teres Minor, and Subscapularis

Question #2 – What is AT LEAST one maneuver to assess each of these muscles

Keep in mind, there are several maneuvers of the shoulder and many overlap into other structures. These are the more common individual maneuvers that I think general practice PAs need to know.

Supraspinatus

Drop Arm test

Description – Patient is seated with examiner to the front. Examiner grasps the patient’s wrist and passively abducts the patient’s shoulder to 90 degrees. Examiner releases the patient’s arm with instructions to slowly lower the arm. Test is positive if the patient is unable to lower his or her arm in a smooth, controlled fashion

Infraspinatus

Dropping Sign

Description – The patient stands with the arm at the side with the elbow at 90 degrees and the humerus medially rotated to 45 degrees. Patient then resists external rotation. Pain or the inability to resist medial rotation indicates a positive test for an infraspinatus strain.

Teres Minor

Hornblower (Patte) Test

Description – Elevate the patient’s arm to 90 degrees in the scapular plane and then flex the elbow to 90 degrees, and the patient is asked to laterally rotate the shoulder. A positive test occurs with weakness and/or pain.

Subscapularis

Lift Off (Gerber) Test

Description – The patient stands and places the dorsum of the hand against mid-lumbar spine. The patient then lifts hand away from the back. An inability to perform this action indicates subscapularis weakness or injury.