Rotator Cuff Injury Tests: Plus Symptoms & Treatments

How to Test for Rotator Cuff Tear and Next Steps to Fix It

By Dr. Erin Boynton, MD, FRCS

We’re going to explain how to do rotator cuff injury tests at home. This way, you can determine what kind of tear you have and what you can do to ease the pain and repair your shoulder. 

It’s possible to tell, without medical imaging, how serious the injury is simply based on what your arms do during these tests. But that’s only step one. We will also get to what you can do to fix it. 

Let’s get started. 

Classifying Rotator Cuff Injuries

Rotator cuff tears fall under many different classifications simply because of the complex nature of the shoulder. It takes four muscles to operate the area. Any single part (or a combo of several) can be affected, all to different severities. 

Most medical professionals will classify rotator cuff injuries by considering the depth of your tear or strain. It offers the most straightforward way to describe the damage. 

  • Grade 1 strains present a tear only up to 3 millimeters deep [1].
  • Grade 2 strains (or partial tear) have a tear between 3 and 6 mm deep or less than half the thickness of the involved tissue. 
  • Grade 3 strains (or full tears) span more than half the thickness of the affected tendon, measuring 6mm or more. 

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How Symptoms Can Suggest Severity

So how do you, on your own, tell A) if you have a rotator cuff strain and B) how severe it is?

We have good news and bad news for you here. 

Determining how bad the tear really is can be difficult based on history and physical examination. You can find some clues when your doctor examines your shoulder.

For example, how weak your shoulder is, but weakness also isn’t a consistent finding with partial rotator cuff tears. 

shoulder weakness test

Advanced imaging, like an ultrasound or MRI, offers the only way to determine the degree of tearing. 

But guess what? 

The degree of tearing almost doesn’t matter because we will treat the condition the same way, no matter how much tearing your tendon has. 

The degree of tearing also doesn’t necessarily correspond to the degree of pain. Sometimes people with a full-thickness tear have no pain, and patients with minimal tearing may have intense chronic pain. 

Now, the bigger the tear, the greater the risk of progression of the tear. That means it’s even more important to change how you load the tendon to stop the tearing in its tracks.

Here’s the good news. 

If you can change how you use your shoulder and stop overloading the tendon, you have a 95% chance of recovery without the need for rotator cuff surgery. 

Most people who need surgery have a significant Grade 3 tear and place substantial demands upon their shoulder. Think of someone who installs drywall for a living or a professional baseball pitcher. 

Before diving into a couple of tests that can help, consider the following symptoms. How do they match with your pain and mobility? 

stretching arms

If you have mild pain in your shoulder, hear clicking when you elevate it, and feel weak when reaching to the rear or overhead – but are still ABLE to move in these ways, you probably have a Grade 1 strain [2].

If you have a Grade 2 tear, you most likely struggle to lift your arm and experience significant pain. 

If you have a Grade 3 strain, you probably can’t lift your arm at all or even raise the elbow away from your torso [3].

If these Grade 2 or 3 symptoms sound familiar, seek medical help and get diagnostic imaging done. These significant injuries require one-on-one treatment to heal properly. 

No matter what type of strain you have, changing how you load your shoulder will help. If necessary, get medical help, and then proceed with exercises to rehab your rotator cuff after testing to see what type of tear you have. 

Testing for Rotator Cuff Tears

You can do a couple of tests that suggest which muscle contains the tear. 

These tests allow you to understand the nature of your injury better. Plus, you can use them as a marker to test your progress as you heal. 

Supraspinatus and Infraspinatus: Drop Arm Test

The Drop Arm Test will tell you if you have a large tear in the supraspinatus and infraspinatus tendons. 

rotator cuff injury tests - drop arm test

  • Have a helper, or use your other arm, to lift your arm up above your head – like you’re raising your hand in school.
  • Slowly lower it all the way back down in front of you. 

If your arm drops down without control once you get past 90°, your supraspinatus and/or infraspinatus likely have large tears [4].

Most people who have large tears here can’t lift their arms above their heads or find it extremely painful. 

Click this link read more about how to rehab a supraspinatus injury.

Teres Minor: Hornblower’s Sign

The Hornblower’s Sign tests the teres minor. Most tests involving muscles require resistance. If there is pain or weakness, then the test indicates a tear – a positive test in medical terms.

rotator cuff injury tests - Hornblower’s Sign

  • To perform the Hornblower’s Sign test, lift your arm to the side at a 90° angle, with your elbow bent to 90° and fingers pointing up.
  • Have a partner gently push against the back of your wrist, and you try to resist the partner pushing your hand down. 

If you feel weak, feel pain, or are unable to do so, you likely have a strained teres minor [5]. Most of the time, the pain will be in the back of the shoulder. 

Infraspinatus Rotator Cuff Test

To test for infraspinatus strength, you will compare both sides. 

rotator cuff injury - Infraspinatus Rotator Cuff Test

  • Hold your arm at your side with 90 degrees of elbow flexion.
  • Have a partner place their hands against the back of your fists.
  • Push against their hands. 

If you have pain or weakness (your partner can easily push your fists toward each other), then that indicates an issue with the infraspinatus. 

Jobe’s Test

The Jobe’s Test assesses your supraspinatus. 

rotator cuff injury tests - Jobe's test

  • Hold your arm at 45 degrees of abduction and flexion, with your thumb pointing down.
  • Have a partner apply pressure. 

If you feel pain at the front of your shoulder and weakness, that indicates pathology in the supraspinatus. 

Don’t forget to always compare to the other shoulder. 

Subscapularis: Lift-off Test

Our last test looks at your subscapularis tendon. 

_rotator cuff injury tests - Subscapularis

  • For the Lift-off Test, bend your elbow to place the hand on the affected side on your lower back.
  • Keep your wrist straight as you try to lift your hand off.
  • Your partner will provide a little resistance. 

If you’re unable to do so, you probably have an injured subscapularis [6]. Sometimes your triceps will try to take over, and your arm will move down to the side and away. That movement also indicates your subscapularis has some weakness. 

Final Thoughts

With any grade of tear, changing how you load your shoulder will give you the best chance at healing and minimizing further wear and tear damage. Grade 1 tears can be fixed at home. Grades 2 and 3 will likely need medical assistance, but wear and wear comes back without changing the root cause. 

You can get started with our free, super easy 8 Minute Shoulder Mobility Routine

It contains 5 quick exercises Coach E developed to improve mobility for everyone, whether you injured your shoulder when you were younger or just want to stop dealing with shoulder pain. 

To dive into the anatomy and underlying causes – including indicators in how you sit and stand – read our article The Fastest Way to Rehab a Strained Rotator Cuff. It also contains Dr. B’s go-to method for immediately settling down shoulder pain. 

About the Author

Dr. Erin Boynton, MD, FRCS is an orthopedic surgeon who was the team surgeon for the Toronto Blue Jays for 10 years and has worked with other professional teams and athletes from many different sports. She currently serves as the Chief Medical Director of the Rogers Cup WTA Tennis Tournament and is the ITF Canadian Champion in tennis for her age group (we won't say which group that is!).