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Acute traumatic rotator cuff tear following anterior shoulder dislocation — MSRA MCQ

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HardShoulder InjuriesAcute traumatic rotator cuff tear following anterior shoulder dislocationMSRA

A 57-year-old woman is reviewed in general practice 6 days after an anterior shoulder dislocation sustained when she fell onto an outstretched arm. In the emergency department, the shoulder was reduced and pre- and post-reduction radiographs showed no fracture. Her pain is improving, but she cannot actively initiate abduction beyond 25 degrees. Passive abduction is 160 degrees. External rotation is markedly weak. Sensation over the lateral deltoid and throughout the hand is normal, radial pulse is present, and there is no recurrent deformity. What is the most appropriate next step?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Arrange urgent shoulder/orthopaedic assessment for a suspected acute traumatic rotator cuff tear

Explanation lettering: C = shown as A · A = shown as B · D = shown as C · B = shown as D

This pattern is strongly suggestive of an acute traumatic rotator cuff tear after a reduced anterior dislocation. The decisive findings are preserved passive range with profound loss of active abduction and external-rotation weakness: this indicates failure of the cuff force couple rather than pain-limited stiffness alone. Her age is also important: UK referral guidance identifies suspected acute traumatic cuff tear in people under 60 years as an urgent referral indication. Recent shoulder dislocation is a further reason to actively seek cuff injury rather than assume uncomplicated post-dislocation recovery. B would be appropriate for a stable shoulder injury without substantial weakness or loss of function, but would risk delaying assessment of a potentially repairable acute tear. C is plausible because ultrasound may demonstrate cuff pathology, but urgent specialist assessment should not be delayed while awaiting routine community imaging; the receiving service can determine the most appropriate imaging pathway. D is incorrect because the shoulder is clinically reduced, with no deformity, and neurovascular findings are normal; same-day emergency assessment is indicated for suspected unreduced dislocation, fracture or significant neurovascular compromise. E is inappropriate because prolonged immobilisation does not address the suspected tear and increases stiffness risk.

Reference: Upper limb | Right Decisions, NHS Borders (2025 (page marked published last year; checked 15 August 2026)) — https://www.rightdecisions.scot.nhs.uk/borders-ref-help-toolkit/physiotherapy/msk-physiotherapy/upper-limb/ Physical examination tests in the acute phase of shoulder injuries with negative radiographs: a diagnostic accuracy study (2025) — https://pubmed.ncbi.nlm.nih.gov/40462009/ Rotator cuff tear and glenohumeral instability: a systematic review (2013) — https://pubmed.ncbi.nlm.nih.gov/24043432/