import { HighYieldBox, ExamCheatSheet, Tabs, Tab, ComparisonTable, VivaScenario, ContentSection, SpecialTestCard , MedicalImage} from '@/components/content' # Shoulder Rotator Cuff Examination The rotator cuff examination tests each of the four muscles individually. Examiners expect you to know the specific tests for supraspinatus, infraspinatus, teres minor, and subscapularis. Lag signs indicate complete tears, while weakness with pain may indicate partial tears or tendinopathy. ## Quick Reference One-Pager ## Rotator Cuff Anatomy **Rotator Cuff Muscles (SITS):** | Muscle | Origin | Insertion | Innervation | Action | |--------|--------|-----------|-------------|--------| | Supraspinatus | Supraspinous fossa | Greater tuberosity (superior) | Suprascapular (C5,6) | Abduction initiation | | Infraspinatus | Infraspinous fossa | Greater tuberosity (middle) | Suprascapular (C5,6) | External rotation | | Teres Minor | Lateral scapula | Greater tuberosity (inferior) | Axillary (C5,6) | External rotation | | Subscapularis | Subscapular fossa | Lesser tuberosity | Subscapular (C5,6) | Internal rotation | **Tear Patterns:** - Most tears begin in supraspinatus - Progression: Supraspinatus → Infraspinatus → Subscapularis - Massive tear: 2+ tendons or greater than 5cm ## Supraspinatus Tests ## Infraspinatus Tests ## Subscapularis Tests ## Additional Tests ## Interpretation **Pain with Weakness:** - Tendinopathy (intact cuff) - Partial tear - Pain inhibition of intact muscle **Weakness without Pain:** - Complete tear (lag sign positive) - Neurological (suprascapular nerve) **Massive Rotator Cuff Tear Signs:** - Multiple positive tests - Pseudoparalysis (cannot actively elevate arm) - Positive drop arm - Multiple lag signs - Atrophy in supraspinatus and infraspinatus fossae **Lag Signs = Complete Tears:** - External rotation lag sign → Infraspinatus tear - Drop arm test → Supraspinatus tear - Internal rotation lag sign → Subscapularis tear Lag signs have HIGH SPECIFICITY - if positive, the tear is almost certainly complete. ## Summary Presentation ## Common Patterns Table ## Examiner Tips