Strength testing should be performed in an attempt to isolate the different components of the rotator cuff to assess weakness. The ‘lift-off’ test (Figure ) can help to assess subscapularis integrity. 28 Although clinically useful, placing the arm in the testing position can be provocative and difficult to achieve, especially in the older population. The ‘belly-press’ test (Figure ) can also help determine integrity of the subscapularis. 29 Resisted external rotation with the elbow by the side is useful in detecting tears extending into the infraspinatus (Figure ). Jobe’s test (Figure ) is most useful in isolating the integrity of supraspinatus. 30 A recent study suggested that if a patient was older than 60 years and had a positive Neer or Hawkins–Kennedy impingement test with weakness in abduction (positive Jobe’s), there was a 98% chance that the patient had a full-thickness rotator cuff tear. 27
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