Shoulder range of motion characteristics in collegiate baseball players.

BACKGROUND: To determine range of motion and capsular characteristics of dominant and nondominant shoulders in baseball players. Our hypothesis was that there is a significant difference between dominant and nondominant range of motion in collegiate baseball players with unoperated and without shoulder pain. METHODS: Design: prospective, range of motion measurements during regular season. Setting: two collegiate baseball teams in Houston. Participants: 15 pitchers and 23 position players. Main outcome measures: shoulder range of motion was evaluated by goniometric technique in all baseball players. Horizontal adduction (cross body reach test) and active internal rotation (reach behind back) in standing position and external rotation and internal rotation in supine lying position were measured for each player. RESULTS: Average external rotation with the arm in 90 degrees of abduction was significantly greater and average internal rotation was less in the dominant shoulder than in the nondominant shoulders, both in pitchers and position players. There was no statistical difference in shoulder horizontal adduction. Both dominant and nondominant shoulders of pitchers had greater average range of motion in horizontal adduction and external rotation at 90 degrees of abduction and less average internal rotation than those of position players. Although there was a significant difference in active internal rotation as cm between dominant and nondominant shoulders both in both groups, no difference was found between pitchers and position players. CONCLUSIONS: Differences in the range of motion in the throwing shoulder of baseball players exist involved in overhead throwing motions and should be considered in rehabilitation of the upper extremity after injury and in the prevention of injury for pitchers and position players.     

Repair of rotator cuff tears in tennis players.

Twenty-three tennis players with a symptomatic full-thickness rotator cuff tear underwent anterior acromioplasty and rotator cuff repair. There were 8 small tears (less than 1 cm), 5 moderate tears (1 to 3 cm), 2 large tears (3 to 5 cm), and 8 massive tears (greater than 5 cm). The dominant shoulder was involved in all patients and all were unable to play tennis before surgery. Eleven patients experienced a traumatic event that caused an injury, 6 while playing tennis, and 12 patients had a gradual onset of symptoms. At average follow-up of 42 months, 19 patients (83%) achieved a good result, were pain-free, and were able to play tennis at their presymptomatic competitive level. Three patients (13%), all with massive tears, had a satisfactory result and were able to play tennis, although at a lower competitive level secondary to weakness. One patient (4%), who also had a massive tear, had an unsatisfactory result and was unable to play tennis.     

Rotator cuff tears in middle-aged tennis players: results of surgical treatment

BACKGROUND: Tennis players, like participants in other overhead sports, are vulnerable to rotator cuff tears. In players who continue to play into their middle-age years, the incidence of such injury increases. HYPOTHESIS: Surgical treatment of rotator cuff tears in middle-aged tennis players is largely successful in allowing return to tennis. STUDY DESIGN: Retrospective review. METHODS: We evaluated the results of surgical treatment of 51 middle-aged tennis players (average age, 51 years) with a rotator cuff tear in their dominant shoulder. Tennis participation among the group had averaged 3.5 hours per week for an average of 25 years. Forty-two patients underwent open repair of the tear with or without biceps tenodesis, whereas 9 patients underwent arthroscopic debridement of the tear with or without a biceps tenotomy. Patients were reviewed at an average of 57 months after surgery with an activities score, a subjective questionnaire, and a questionnaire regarding their postoperative participation in tennis. RESULTS: The activities score averaged 26.6 of 30 possible points. Forty-seven patients were satisfied with their result, and 40 patients were able to return to tennis at an average of 9.8 months after surgery. No difference was found in the ability to return to tennis between the open repair group and the arthroscopic debridement group. CONCLUSIONS: The results of this study indicate that it is possible for nearly 80% of middle-aged tennis players to return to participation after operative treatment of rotator cuff tears.     

Quantitative assessment of glenohumeral translation in baseball players: a comparison of pitchers versus nonpitching athletes

BACKGROUND: Objective data quantifying differences in glenohumeral range of motion in baseball pitchers versus position players are established. There is limited information objectively comparing glenohumeral laxity in this same population. HYPOTHESIS: Baseball pitchers have greater difference in side-to-side anteroposterior translation of their throwing shoulders compared with position players. STUDY DESIGN: Prospective cross-sectional study. METHODS: Cutaneous electromagnetic sensors quantified anteroposterior shoulder translation of college and professional baseball players. Range of motion was measured. RESULTS: Nineteen position players and 37 pitchers were studied. Pitchers had a significant increase in external rotation of the dominant arm as compared with the nondominant arm (P = .02); the difference was not significant in position players (P = .34). The mean range of motion for pitchers' dominant arm was 110 degrees external rotation to 68 degrees internal rotation, and it was 100 degrees external rotation to 85 degrees internal rotation for position players (P = .278). The mean anteroposterior translation in pitchers' dominant arm was 33.30 mm and 29.84 mm in the nondominant side (P = .0001). This difference was not present in position players (P = .88). One of 19 position players had a side-to-side shoulder translation difference greater than 3 mm, compared with 22 of 37 pitchers (P = .0001). CONCLUSIONS: Pitchers have a greater amount of glenohumeral translation in the dominant arm. This difference is not seen in position players. These differences make the side-to-side comparison less useful in pitchers and should be considered when making therapeutic decisions.     

Greater tuberosity notch: an important indicator of articular-side partial rotator cuff tears in the shoulders of throwing athletes.

We examined the location of rotator cuff tears, associated labral injuries, and notches on the greater tuberosity of the humeral head in shoulders of throwing athletes. Arthroscopic findings (rotator cuff tear, labral condition, and greater tuberosity notch) as well as other factors (duration of playing baseball, range of motion, and joint laxity) of 61 baseball players were retrospectively studied. The presence of a greater tuberosity notch was also evaluated for by plain radiographs. Forty patients had articular-side partial rotator cuff tears, most of which occurred in the interval between the supraspinatus and infraspinatus tendons. The existence of a rotator cuff tear was not related to the range of motion, joint laxity, the detachment of the superior glenoid labrum, or posterosuperior labral injury. Greater tuberosity notches were recognized in 38 shoulders by arthroscopy and most were detected on plain radiographs. The presence of a notch was significantly related to the existence of a rotator cuff tear, while the size of the notch was significantly related to the depth and width of the tear. The greater tuberosity notch seems to be one of the most important diagnostic indicators for a rotator cuff tear in throwing athletes.     

MR imaging of shoulder injuries in professional baseball players.

Magnetic resonance (MR) imaging was used to evaluate the shoulders of 10 symptomatic professional baseball players and one asymptomatic player, with surgical correlation in six cases and arthrographic correlation in two cases. Seven small rotator cuff tears measuring 0.5-1 cm were identified on MR images, with arthrographic and surgical confirmation of these findings in two patients and surgical confirmation only in three patients. Cortical irregularity and/or subchondral cyst formation at the posterior aspect of the greater tuberosity near the insertion site of the infraspinatus tendon was found in five of the seven players with rotator cuff tears. Similar findings were noted in the asymptomatic volunteer and in one of the three players without cuff tear, who also had irregular thickening of the posterior capsule. These findings are believed to represent chronic avulsive changes resulting from the deceleration stresses of the follow-through motion.     

Sonography of the postoperative shoulder

Fifty-three patients with 60 symptomatic shoulders underwent shoulder sonography for recurrent postoperative symptoms after either acromioplasty (10 shoulders) or repair of a full-thickness rotator cuff tear in addition to acromioplasty (50 shoulders). Because surgery distorts landmarks, an understanding of the surgical procedures and their characteristic sonographic appearances is essential. After acromioplasty, the characteristic sharp margination or the acromion was replaced by a less distinct, irregular surface. After repair of a cuff tear, characteristic sonographic appearances included visualization of a reimplantation trough and loss of the echogenic subdeltoid bursa. When the cuff was intact after surgery, echogenicity was abnormal in all cases (17 shoulders). Sonography accurately diagnosed recurrent cuff tears in all 26 shoulders in which surgical proof was available and confirmed an intact cuff in 10 of 11 cases. In one shoulder, a cuff hematoma was incorrectly interpreted as a full-thickness tear. These findings suggest that sonography is an effective procedure for evaluating a postoperative patient with recurrent shoulder symptoms.     

Magnetic resonance imaging of the asymptomatic shoulder of overhead athletes: a 5-year follow-up study

BACKGROUND: Although several studies have described magnetic resonance imaging findings in shoulders of asymptomatic volunteers, no such investigation has been performed on asymptomatic dominant and nondominant shoulders of elite overhead athletes. HYPOTHESIS: Asymptomatic dominant shoulders of elite overhead athletes may have a higher incidence of magnetic resonance imaging abnormalities than either their nondominant shoulder or shoulders of asymptomatic volunteers. STUDY DESIGN: Prospective cohort study. METHODS: Detailed magnetic resonance imaging scans of asymptomatic dominant and nondominant shoulders of elite overhead athletes were obtained. Three experienced musculoskeletal radiologists interpreted each scan for multiple variables, including rotator cuff appearance. Images from a surgical control group were intermixed to assess accuracy and control for observer bias. A 5-year follow-up interview was performed to determine whether magnetic resonance imaging abnormalities found in the initial stage of the study represented truly clinical false-positive findings or symptomatic shoulders in evolution. RESULTS: Eight of 20 (40%) dominant shoulders had findings consistent with partial- or full-thickness tears of the rotator cuff as compared with none (0%) of the nondominant shoulders. Five of 20 (25%) dominant shoulders had magnetic resonance imaging evidence of Bennett's lesions compared with none (0%) of the nondominant shoulders. None of the athletes interviewed 5 years later had any subjective symptoms or had required any evaluation or treatment for shoulder-related problems during the study period. CONCLUSIONS: Magnetic resonance imaging alone should not be used as a basis for operative intervention in this patient population.     

Outcome and structural integrity after arthroscopic rotator cuff repair using 2 rows of fixation: minimum 2-year follow-up

BACKGROUND: Although arthroscopic repairs of the rotator cuff are becoming increasingly popular, security of fixation remains a concern. Two-row repairs have been described, but clinical outcome reports have primarily involved open techniques. HYPOTHESIS: An arthroscopic repair technique that uses 2 rows of fixation produces satisfactory outcome and structural integrity by ultrasonography. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Forty-eight patients (52 shoulders) with a full-thickness, but fully reducible, rotator cuff tear who met the inclusion criteria were treated with an arthroscopic rotator cuff repair using 2 rows of suture anchors. The mean tear size was 2.47 cm (range, 1-4 cm). Patients were evaluated by subjective functional assessment (L'Insalata Shoulder Rating Questionnaire), clinical examination, including measured strength testing, and ultrasonography. RESULTS: At a mean follow-up of 30 months (minimum of 2 years), functional scores improved from a mean of 42 preoperatively to 93 postoperatively (P < .001). Active range of motion was increased in all measured planes (P < .001). Strength was also increased in elevation (P < .001), external rotation (P < .001), and internal rotation (P = .033). Nine of the 52 shoulders (17%) had evidence of retear or persistent defect on postoperative ultrasonography. There were no differences detected in functional scores between those with an intact repair and those with a defect, but those with an intact repair were stronger in elevation (P = .006) and external rotation (P = .001). CONCLUSION: An arthroscopic 2-row rotator cuff repair produces excellent functional outcome and repair integrity comparable with previously reported open repairs. Presence of a defect after repair did not appear to affect patient-reported function and return to preinjury activity but did affect measured strength.     

Interobserver agreement in the classification of rotator cuff tears

BACKGROUND: Six classification systems have been proposed for describing rotator cuff tears designed to help understand their natural history and make treatment decisions. PURPOSE: To assess the interobserver variation for these classification systems and identify the method with the best interobserver agreement. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 2. METHODS: Six rotator cuff tear classification systems were identified in a literature search. The components of these systems included partial-thickness rotator cuff tears and classification by size, shape, configuration, number of tendons involved, and by extent, topography, and nature of the biceps. Twelve fellowship-trained orthopaedic surgeons who each perform at least 30 rotator cuff repairs per year reviewed arthroscopy videos from 30 patients with a random assortment of rotator cuff tears and classified them by the 6 classification systems. Interobserver variation was determined by a kappa analysis. RESULTS: Interobserver agreement was high when distinguishing between full-thickness and partial-thickness tears (0.95, kappa = 0.85). The investigators agreed on the side (articular vs bursal) of involvement for partial-thickness tears (observed agreement 0.92, kappa = 0.85) but could not agree when classifying the depth of the partial-thickness tear (observed agreement 0.49, kappa = 0.19). The best agreement for full-thickness tears was seen when the tear was classified by topography (degree of retraction) in the frontal plane (observed agreement 0.70, kappa = 0.54). CONCLUSION: With the exception of distinguishing partial-thickness from full-thickness rotator cuff tears and identifying the side (articular vs bursal) of involvement with partial-thickness tears, currently described rotator cuff classification systems have little interobserver agreement among experienced shoulder surgeons. Researchers should consider describing full-thickness rotator cuff tears by topography (degree of retraction) in the frontal plane.     

Functional outcome and health-related quality of life after surgical repair of full-thickness rotator cuff tear using a mini-open technique

BACKGROUND: Rotator cuff tear, a common shoulder injury, can lead to shoulder pain and functional loss. HYPOTHESIS: Surgical repair of full-thickness rotator cuff tears using the mini-open surgical technique will improve shoulder function and health-related quality of life. STUDY DESIGN: Cohort study. Level of evidence, 2. METHODS: Patients with a full-thickness rotator cuff tear who underwent a mini-open repair were evaluated for (1) active shoulder range of motion preoperatively, and 6 months and 12 months postoperatively and (2) health-related quality of life preoperatively, 6 months postoperatively, and annually up to 5 years postoperatively. Satisfaction with the repair and return to work status were ascertained 1 year postoperatively. A subgroup analysis of tear size and patient age was also undertaken. RESULTS: Of the subjects, 61 (73%) were men, and the average age was 53.2 ( +/- 9.9) years. According to repeated-measures analysis of variance, shoulder range of motion (flexion and external rotation) improved significantly from before surgery to 1 year after surgery (P <.001). The mean American Shoulder and Elbow Surgeons scores improved from 53.3 ( +/- 20.6) preoperatively to 90.6 ( +/- 11.7) 1 year postoperatively (P <.001). The mean Western Ontario Rotator Cuff scores also improved from 43.2 ( +/- 20.2) preoperatively to 87.2 ( +/- 14.3) 1 year postoperatively (P <.001). No differences were seen in either the American Shoulder and Elbow Surgeons scores or Western Ontario Rotator Cuff scores between the 1-year examination and the last follow-up assessment undertaken at a median of 5 years postoperatively (P >.05). Ninety-six percent of patients were satisfied or very satisfied with the results of their repair; 78% of patients who were working before surgery returned to work without modification by 1 year postoperatively. For the most part, patient age and size of tear did not influence postoperative range of motion or health-related quality of life. CONCLUSION: Mini-open rotator cuff repair led to improved shoulder function and health-related quality of life up to 5 years postoperatively.     

Patterns of vascular and anatomical response after rotator cuff repair

BACKGROUND: It has been assumed that a robust vascular response at the tendon to bone interface during rotator cuff repairs is an integral part to the healing process. There are few studies that have explored this in an in-vivo prospective fashion. PURPOSE: To prospectively characterize vascular and anatomical patterns in repaired rotator cuff tendons using Power Doppler sonography in a double-blinded fashion. STUDY DESIGN: Case control study; Level of evidence, 3. METHODS: Fifty patients undergoing rotator cuff repair were enrolled: 28 mini-open, 14 open, and 8 arthroscopic repairs; 20 patients were controls. Patients underwent Power Doppler sonography at 6 weeks, 3 months, and 6 months postoperatively. Power Doppler sonography analysis examined 6 areas of the rotator cuff repair: discretely marginated intrasubstance, partial-thickness defects, full-thickness defects, focal thinning of repair, presence of bursal or joint fluid, and location of anchors. A subjective scoring system assessed blood flow in each region. RESULTS: There was a predictable, significant decrease in vascular scores after rotator cuff repair over time. The mean vascular score was 11.6 at 6 weeks, 8.3 at 3 months, 7.0 at 6 months, and 2.4 for controls. There was a significant difference (P < .05) in vascular recruitment scores between each time period, with the most robust flow at the peritendinous region. The lowest vascular score was at the anchor site or cancellous trough. Forty-eight percent of the patients had a rotator cuff repair defect postoperatively. These findings did not correlate with functional assessment and outcome at 6 months. There was no significant difference in vascular scores between the defect and no-defect groups. Mean University of California, Los Angeles; L'Insalata; and American Shoulder and Elbow Surgeons scores at 6 months were 28.6, 86.3, and 81.5, respectively. Thirty-three percent of asymptomatic controls had a rotator cuff tear that averaged 7.6 x 7.1 mm. CONCLUSION: The robust vascular response dropped with time, which is not seen in asymptomatic shoulders. Nearly half of the patients demonstrated persistent rotator cuff defects after rotator cuff repair that did not correlate with functional outcome and physical findings at 6 months.     

Full-thickness tears of the rotator cuff of the shoulder: diagnosis with MR imaging.

The purpose of this study was to describe MR findings in full-thickness tears of the rotator cuff. Of 102 shoulders examined by MR imaging, 31 were found to have a full-thickness tendon tear at arthroscopy/bursoscopy (five shoulders) or open surgery (26 shoulders). All shoulders were imaged in oblique coronal and axial planes. MR images of the 102 shoulders were evaluated for (1) the presence of fluid in the subacromial and subdeltoid bursae; (2) abnormal signal of the supraspinatus, subscapularis, infraspinatus, and teres minor tendons; (3) interruption of tendon continuity and thinning of the tendon; and (4) proximal retraction of the junction of the muscle and tendon. The presence or absence of each finding was determined by consensus of two radiologists, who interpreted the images without knowledge of the surgical findings. Results in those 31 shoulders with proved full-thickness tears were: fluid in the subacromial bursae (29 shoulders), interruption of tendinous continuity (22 shoulders), focally increased signal of the tendon equivalent to that of water (27 shoulders), and musculotendinous retraction (24 shoulders). The finding of subacromial fluid was a sensitive indicator (93%) of a full-thickness tear, and interruption of tendinous continuity was a specific finding (96%) in diagnosing a full-thickness tear. Our experience shows interruption of tendon continuity is the most specific MR finding of full-thickness rotator cuff tears, while subacromial fluid is the most common finding.     

Operative repair of anterior instability and rotator cuff tears in athletes

Rotator cuff tears in individuals under age 40 are uncommon; especially rare is the younger patient with acombination of full thickness rotator cuff tear and a Bankart lesion. Operative management of this challenging patient must provide for a “stable” repair of both lesions to allow for optimal rehabilitation. Our surgical preference includes arthroscopic subacromial decompression, rotator cuff repair, and a formal open capsulolabral reconstruction. Based on surgeon preference and skill, a mini-open or arthroscopic repair can be performed. This approach allows for a more aggressive rehabilitation to facilitate a full return to activity levels.     

Humeral avulsions of the inferior glenohumeral ligament complex involving the axillary pouch in professional baseball players

Introduction

Humeral avulsion of the inferior glenohumeral ligament is a rare injury in athletes and can involve different parts of the complex. Axillary pouch avulsion, in particular, has only recently been recognized in the literature, but has never been described in professional baseball pitchers.

Materials and methods

A retrospective review of professional baseball players presenting to our institution over 5 years was performed. Patients with Bankart lesions or fractures were excluded. Preoperative MRI was retrospectively correlated with the clinical and arthroscopic findings, as available.

Results

Four professional baseball pitchers were identified, all who had axillary pouch humeral avulsions of the inferior glenohumeral ligament. There was a concomitant avulsion of the anterior band in one patient. Associated findings included labral tears (n?=?2) and partial thickness tear of the rotator cuff (n?=?2). Three patients ultimately had their axillary pouch avulsions repaired at most recent follow-up.

Conclusions

APHAGL lesions can be seen in overhead athletes such as baseball pitchers and should be carefully considered as a potential cause of disability. Appropriate diagnosis is important to ultimately elucidate the optimal management of these lesions.     

MR assessment of the repaired rotator cuff: prevalence, size, location, and clinical relevance of tendon rerupture

The objectives of this study were to use magnetic resonance (MR) imaging to evaluate the prevalence, size, location, and clinical relevance of tendon rerupture following complete repair of full-thickness rotator cuff tear (RCT). A total of 78 surgically proven full-thickness rotator cuff tears in 74 patients were retrospectively included in the study. Clinical assessment was performed using the University of California at Los Angeles score. Postoperative MR imaging was evaluated to determine prevalence, size, and location of tendon rerupture. At a mean 48.4 months’ follow-up, 62 shoulders (79.5%) had favorable outcomes and 45 shoulders (57.6%) showed rerupture on MR imaging studies. Reruptures were significantly more prevalent among patients with intermediate-to-bad outcomes (81.3%), with surgically demonstrated two-tendon tears (78.9%) or three-tendon tears (100%), and with preoperative fatty degeneration of the supraspinatus muscle greater than 1 (91.6%). Reruptures were also significantly larger in those subgroups. Complete repair of RCT of all sizes may have favorable outcomes in a significant proportion of patients in spite of a high prevalence of reruptures. Preoperative tear size and degree of muscle fatty degeneration influence the prevalence and rerupture size. After repair of supraspinatus tears, reruptures tend to invade the posterior aspect of the tendon.     

Ultrasonographic rotator-cuff changes in veteran tennis players: the effect of hand dominance and comparison with clinical findings

The aim of this study was to correlate sonographic abnormalities of the rotator cuff with clinical findings in veteran tennis players. One hundred fifty individuals playing competition-level tennis, aged from 35 to 77 years (mean age 55 years), underwent physical and US examinations of their shoulders. The US abnormalities found in the dominant shoulder were compared with those observed in the non-dominant shoulder and in different subsets of players defined by the absence or presence of former and/or current pain. Tears of the long head of the biceps tendon were seen only in dominant shoulders (n=8), and tears (23 complete and 20 partial) of the supraspinatus tendon were observed in 43 dominant vs 16 (3 complete and 13 partial) contralateral shoulders (p<0.001). Subscapularis tendon calcifications were depicted in 23 dominant vs 12 contralateral shoulders (p<0.05). Seventy players had no pain, 49 had former-but-not-current pain, and 31 had current pain. Abnormal thickening (>2 mm) and effusion of the subacromial–subdeltoid bursa and complete tear of the supraspinatus tendon were more frequent in the latter two groups (p<0.001 and p<0.05), respectively. Although 90% of the players with a complete supraspinatus tear had experienced former pain, no relationship was found between current pain and the presence of a supraspinatus tear or tendon calcification. The rotator cuff may present important asymptomatic lesions, such as complete tears of the supraspinatus tendon or calcifications, that do not prevent the playing competitive tennis. The only US abnormality associated with pain was subacromial–subdeltoid bursa effusion.     

Repair of the rotator cuff. Mini-open and arthroscopic repairs

The repair of rotator cuff tears by traditional open subacromial decompression and rotator cuff tendon reapproximation has proved successful in restoring function and decreasing pain, but open rotator cuff repair has some inherent disadvantages. Postoperative detachment of the deltoid repair has been reported and results in significant morbidity. The open technique may also require a longer period of limited motion resulting in greater stiffness. Arthroscopically assisted mini-open repairs and, more recently, completely arthroscopic repairs of the rotator cuff have been developed and increasingly are being applied. Both techniques avoid detachment of the deltoid. The mini-open and arthroscopic approaches to rotator cuff repair have the added benefit of arthroscopic evaluation of the glenohumeral joint. The mini-open technique has the advantage of allowing the direct visualization of the cuff repair and allows surgeons to place the stitches in an open fashion, which is familiar to all surgeons. The mini-open technique also allows the placement of tension-absorbing stitches in the rare cases that they are needed. Mini-open techniques also allow the choice of bone anchors or osseous tunnels for fixation. The completely arthroscopic cuff repair has several potential advantages over the open and mini-open cuff repair techniques; first is the decreased disruption of the soft tissues, which may result in less scarring and adhesions. The procedure is the most cosmetically appealing of the techniques. Reduced postoperative pain is also cited as an advantage but has been demonstrated only in a single, nonrandomized study. Finally, if technical difficulties arise, the conversion to a mini-open repair can be done easily. In a few studies, arthroscopic cuff repair techniques have shown promise as an alternative to mini-open or open repair, but these results have been at the hands of a few surgeons who have extensive experience in arthroscopy of the shoulder. In contrast, the mini-open procedure requires modest arthroscopic skills and has a documented history of success. Nevertheless, arthroscopic rotator cuff repair is a viable and effective technique in the hands of surgeons with adequate skills, and this procedure is likely to become more commonly performed in the future as shoulder arthroscopic skills and instrumentation improve.     

The rotator cuff functional index

BACKGROUND: Despite improvements in the clinical assessment of rotator cuff injuries, shortcomings exist in diagnosing rotator cuff tears. PURPOSE: To formulate a clinical rotator cuff functional index for predicting rotator cuff tears based on handheld dynamometer measurements for shoulder strength testing and to assess its ability to diagnose a rotator cuff tear. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 2. METHODS: Preoperative handheld dynamometer measurements, including supraspinatus, external rotation, internal rotation, adduction, and lift-off force, were compared in 100 patients with full-thickness rotator cuff tears (> 1.0 cm) and 100 patients with no rotator cuff injury (confirmed by arthroscopy). Using multiple logistic regression analysis, the rotator cuff functional index and index for rotator cuff tear size were formulated in which 100 represented excellent rotator cuff function and less than 0 indicated a full-thickness supraspinatus tear. Each patient's index was calculated to determine its clinical value in predicting a rotator cuff tear; the Pearson correlation coefficient was established for the rotator cuff functional index for rotator cuff size. RESULTS: Two handheld dynamometer measurements predicted a rotator cuff tear (P < .001, r = 0.53), with rotator cuff functional index = 1.27 * supraspinatus (N) - 0.72 * adduction (N) - 11.6, but not tear size (r = 0.38). In predicting a rotator cuff tear (rotator cuff functional index < 0 = rotator cuff tear; rotator cuff functional index > 0 = no tear), the rotator cuff functional index had 83% sensitivity, 79% specificity, 80% positive predictive value, 82% negative predictive value, likelihood ratio of 4.0 for a positive test result and 0.2 for a negative test result and an accuracy of 81%. CONCLUSION: The 2 most useful tests for determining a rotator cuff tear with a handheld dynamometer were supraspinatus force and adduction force (as negative control). A functional index based on these measurements was able to rule out a rotator cuff tear and predict the presence but not the size of the tear.