skip to main content

Suspected acute traumatic rotator cuff tear — MSRA MCQ

Instant feedback + full explanation. One question, done properly.

HardShoulder InjuriesSuspected acute traumatic rotator cuff tearMSRA

A 58-year-old right-handed self-employed joiner presents 4 days after slipping from a low ladder and landing on his outstretched right arm. He had immediate shoulder pain and has since been unable to lift tools above waist height. He has no paraesthesia, neck pain, fever or systemic symptoms. Examination shows marked weakness and pain on resisted abduction and external rotation. Active abduction is limited to 35 degrees, whereas passive abduction reaches 160 degrees. There is no visible deformity, the arm is well perfused, and sensation over the lateral deltoid is normal. Anteroposterior and axial shoulder radiographs show no fracture or glenohumeral dislocation. What is the most appropriate next step in management?

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

Reveal the answer and explanation

Correct answer: C — Arrange urgent shoulder ultrasound and urgent referral for orthopaedic shoulder assessment

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

This presentation is strongly suggestive of an acute traumatic rotator cuff tear. The linked discriminators are recent trauma, substantial loss of active movement and objective weakness, with relatively preserved passive movement. Normal plain radiographs exclude an evident fracture or unreduced glenohumeral dislocation but do not exclude a clinically important cuff tear. In UK primary-care referral guidance, a younger patient with traumatic cuff tear should have AP and axial radiographs to exclude fracture avulsion, urgent ultrasound, and urgent orthopaedic assessment. At 58 years, with a high functional demand and marked weakness in abduction and external rotation, this patient should not first complete a prolonged conservative-treatment pathway. A is appropriate for many non-traumatic or degenerative cuff disorders, but delays assessment of a potentially repairable acute tear. C is attractive after trauma with severe restriction, but there is no unreduced dislocation, fracture, neurovascular compromise or sepsis requiring same-day emergency management. D may ultimately define tear morphology, but routine MRI should not delay urgent specialist assessment; ultrasound is the specified initial urgent investigation in the relevant UK pathway. E is inappropriate before diagnostic clarification in an acute traumatic weakness syndrome and does not address the need for urgent assessment of a possible full-thickness tear.

Reference: NHS Tayside RefGuide: Rotator Cuff Tear (Current page; next review date 04/07/2027) — https://www.rightdecisions.scot.nhs.uk/nhs-tayside-refguide/surgery-and-orthopaedics/orthopaedic-and-trauma-surgery/shoulder-and-elbow/rotator-cuff-tear/?UNLID=22638775202621594927 NHS Dumfries and Galloway RefHelp: Shoulder (Current page; published 2024) — https://www.rightdecisions.scot.nhs.uk/dg-refhelp/musculoskeletal-system/shoulder/ NHS Tayside RefGuide: Shoulder and Elbow (Current page) — https://www.rightdecisions.scot.nhs.uk/nhs-tayside-refguide/surgery-and-orthopaedics/orthopaedic-and-trauma-surgery/shoulder-and-elbow/