There are over a hundred tests described for examining the shoulder. The aim of this study is to present those clinical tests that we have found by research and practice to be helpful when assessing disorders of the shoulder. In brief, we have found the key steps as follows: (1) stiffness is ruled out by checking passive external rotation;(2) evaluate external rotation and supraspinatus power and impingement signs for rotator cuff tears; (3) O'Brien's sign for superior labral anterior posterior lesions; (4) modified cross arm sign/Modified O'Brien's sign for acromioclavicular pain; and (5) instability tests if there is a positive history.

Introduction: Massive rotator cuff tears are difficult to manage. A treatment option is the use of a synthetic patch as an interpositional bridge to restore the continuity of the cuff defect. The aim of this paper was to evaluate the early clinical results of these techniques compared with the standard direct tendon to bone repair. Methods:A retrospective case-controlled study was performed on patients with massive (Z15 cm 2 ) rotator cuff tears who underwent an arthroscopic direct tendon to bone repair and patients with irreparable rotator cuff tears who underwent arthroscopic patch interposition using multiple mattress technique or a novel weave technique at the patch to tendon interface. Results:Of the 801 arthroscopic rotator cuff repairs, 37 patients met the inclusion criteria. Of these, 21 underwent direct tendon to bone repair without interpositional patches and 16 underwent interpositional expanded polytetrafluoroethylene (ePTFE) patch repairs (8 with multiple mattress sutures and 8 with a weave repair at the patch to tendon interface). No differences were noted between the 3 groups in terms of patient age (66 ± 3, 64 ± 3, and 63 ± 5 y, respectively), rotator cuff tears sizes (25 ± 3, 25 ± 6, and 19 ± 4 cm 2 ), preoperative subjective pain and function, and strength and range of motion. Overall subjective pain and function improved in all 3 repair groups at 6 months postoperatively (P < 0.05). Supraspinatus strength was superior in the weave technique when compared with the direct tendon to bone (P < 0.001) and the multiple mattress technique (P < 0.001). External rotation strength was better with the weave technique over the direct tendon to bone repair at 6 months (P = 0.01). There was more range of motion in external rotation in the weave technique over the direct tendon to bone repair (P < 0.001) and the multiple mattress technique (P = 0.04). Operative times with the ePTFE reconstructions (64 ± 7 min with the multiple mattress repair and 46 ± 3 min with the weave repair) were longer than the direct tendon to bone repair (33 ± 3 min). At 6 months, ultrasound showed that 10/21 repairs were intact in the direct tendon to bone repair group, whereas all (16/16) repairs with the ePTFE grafts were intact (P = 0.01). Conclusions:The weave arthroscopic method for attaching a synthetic patch to the torn edges of an irreparable rotator cuff tear was faster to perform and gave better supraspinatus and external rotation strength when compared with the multiple mattress repair at 6 months after repair. Tendons repaired with an ePTFE patch were much less likely to retear when compared with tendons repaired directly to the bone.