A patient with shoulder pain reports worse pain at night. Which examination maneuver is most suggestive of rotator cuff pathology?

• A. Empty can test
• B. Drop arm test
• C. Hawkins-Kennedy test
• D. Apprehension test

Answer: (B)

Rotator cuff tears, especially full-thickness ones, are classically tested with a maneuver that assesses whether the patient can eccentrically control the arm as it is lowered from a position of abduction. In this test, the patient abducts the arm to about 90 degrees and then slowly lowers it. If the arm drops suddenly or the patient cannot control the descent due to weakness and pain, this suggests a deficient tendon that can no longer stabilize the arm—characteristic of a rotator cuff tear. Night pain is common with rotator cuff pathology because the irritated tendon and surrounding structures are stressed when lying on the shoulder or during sleep movements. Other maneuvers probe different problems: Hawkins-Kennedy focuses on impingement, the empty can test checks supraspinatus weakness, and the apprehension test assesses instability. The dropping arm test is most specific for a full-thickness rotator cuff tear, making it the best clue among these options.