PCA Study Review: Shoulder Pain, Rotator Cuff Tears, and the Problem with One Test Thinking

PCA Study Review: Shoulder Pain, Rotator Cuff Tears, and the Problem with One Test ThinkingIn this episode of PCA Study Review, a service of the Pennsylvania Chiropractic Association, we review research on shoulder exams, rotator cuff tears, and subacromial impingement.Shoulder exams can get crowded quickly: Neer, Hawkins, Jobe, Drop Arm, Lift Off, Painful Arc, and lag signs. Most doctors know the names. The deeper issue is whether we understand what each test actually tells us.The literature reinforces one clear point: no single shoulder test is perfect. This review focuses on lag signs, particularly the External Rotation Lag Sign at 90 Degrees and the Internal Rotation Lag Sign, to identify full-thickness rotator cuff tears.The larger lesson is not that doctors need one magic test. Better clinical reasoning requires test clusters, context, documentation, and knowing when referral, imaging, or co-management may be appropriate.For chiropractors, this matters because musculoskeletal care depends on skilled examination early in the care pathway. The opportunity is to evaluate carefully, recognize red flags, document clearly, and treat conservatively when appropriate.In This EpisodeWhy one test thinking can weaken the shoulder diagnosisWhy lag signs deserve attention in shoulder evaluationHow high specificity and low sensitivity should affect interpretationWhy familiar tests are not always the strongest testsHow test clusters improve clinical reasoningWhen shoulder findings may require referral, imaging, or co-managementWhy evidence-informed documentation strengthens care and credibilityReference ArticlesZhao, Q., Palani, P., Kassab, N. S., Terzic, M., Olejnik, M., Wang, S., Tomassini-Lopez, Y., Dean, C., & Shellenberger, R. A. Evidence-based approach to the shoulder examination for subacromial bursitis and rotator cuff tears: a systematic review and meta-analysis. BMC Musculoskeletal Disorders, 25, Article 1028, 2024.Hermans, J., Luime, J. J., Meuffels, D. E., Reijman, M., Simel, D. L., & Bierma-Zeinstra, S. M. A. Does This Patient With Shoulder Pain Have Rotator Cuff Disease? The Rational Clinical Examination Systematic Review. JAMA, 310(8), 837–847, 2013.Castoldi, F., Blonna, D., & Hertel, R. External rotation lag sign revisited: Accuracy for diagnosis of full-thickness supraspinatus tear—Journal of Shoulder and Elbow Surgery, 18(4), 529–534, 2009.Miller, C. A., Forrester, G. A., & Lewis, J. S. The Validity of the Lag Signs in Diagnosing Full-Thickness Tears of the Rotator Cuff: A Preliminary Investigation. Archives of Physical Medicine and Rehabilitation, 89(6), 1162–1168, 2008.The shoulder is complex. Rotator cuff disease is common. Pain provocation tests can mislead when used carelessly.The opportunity is to read the research, revisit the exam, and sharpen the clinical reasoning that protects patients and strengthens the profession.PCA Website: https://pennchiro.org/ PCA Email: [email protected]