Reliable diagnosis of posterosuperior rotator cuff tears requires a combination of clinical tests

Knee Surg Sports Traumatol Arthrosc. 2021 Jul;29(7):2118-2133. doi: 10.1007/s00167-020-06136-9. Epub 2020 Jul 28.


Purpose: Clinical diagnosis of posterosuperior rotator cuff tears remains uncertain due to a lack of evidence-based consensus. This review aimed to compare the diagnostic accuracy of commonly used clinical tests for posterosuperior rotator cuff tears.

Methods: The authors conducted an electronic literature search using Medline, Embase and the Cochrane library/Central, to identify original clinical studies reporting diagnostic accuracy of clinical tests to diagnose the presence of posterosuperior rotator cuff tears involving the infraspinatus, supraspinatus and/or teres minor.

Results: The electronic literature search returned 1981 records, of which 14 articles were eligible. Among 17 tests included in the systematic review, 6 tests were eligible for meta-analysis: drop arm sign, Jobe test, external rotation lag sign, Hawkins-Kennedy test, Neer test and painful arc abduction test. According to QUADAS-2 criteria, risk of bias was low in 1 study, moderate in 2 and high in 4. The highest pooled sensitivity was 0.77 (CI 0.67-0.85), for the Jobe test, while the lowest pooled sensitivity was 0.38 (CI 0.01-0.98), for the drop arm sign.

Conclusions: The Jobe test had the best pooled sensitivity, while the drop arm sign had the best pooled specificity. As no single clinical test is sufficiently reliable to diagnose posterosuperior rotator cuff tears, clinicians should consider various combinations of patient characteristics and clinical tests, as well as imaging modalities, to confirm diagnosis and select the appropriate treatment option. More reliable clinical diagnosis of posterosuperior rotator cuff tears could reduce the reliance on magnetic resonance imaging or arthrography and their associated costs and waiting times.

Level of evidence: Level II.

Keywords: Clinical tests; Diagnostic accuracy; Infraspinatus; Meta-analysis; Posterosuperior; Rotator cuff tear; Supraspinatus; Teres minor.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Arthrography
  • Athletic Injuries / diagnosis
  • Athletic Injuries / diagnostic imaging
  • Humans
  • Magnetic Resonance Imaging
  • Physical Examination
  • Rotation
  • Rotator Cuff / diagnostic imaging
  • Rotator Cuff Injuries / diagnosis*
  • Rotator Cuff Injuries / diagnostic imaging
  • Sensitivity and Specificity