Rent Test

The Rent Test, first described by Codman in 1934, is a clinical assessment used to identify rotator cuff tears. The test involves palpation of the anterior insertion of the greater tuberosity of the humerus to detect signs of supraspinatus tendon defects, including crepitus¹.

Rotator cuff tears may vary in size and location, and patients can present with a wide range of symptoms — from no pain and normal function to severe pain and significant disability¹.

Also known as trans-deltoid palpation, the Rent Test is primarily used to diagnose full-thickness rotator cuff tears², and some studies suggest it may be the most reliable clinical test for detecting such tears³. The Rent Test is commonly performed in addition to other rotator cuff assessments such as the Jobe Test, Drop Arm Sign, Belly-Press Test, Lift-Off Test, and Bear-Hug Test to localize the lesion¹.

Test execution

Patient position

• The patient sits in a relaxed position.

• The examiner stands behind the patient.

Procedure

1. The examiner palpates the anterior edge of the acromion through the deltoid muscle.

2. The patient’s arm is grasped at the elbow/forearm (elbow flexed to approximately 90°).

3. The arm is passively extended.

4. The examiner then performs passive internal and external rotation while palpating the rotator cuff tendons.

Interpretation

• Positive test:

  • Palpable or prominent eminence (greater tuberosity of the humerus).

  • Palpable defect or “sulcus” in the tendon, indicating a full-thickness rotator cuff tear²⁴.

Diagnostic validity and evidence

Diagnostic accuracy of the Rent Test:

Parameter	Value (%)
Sensitivity	95.7 – 96.0²⁴
Specificity	96.8 – 97.0²⁴
Positive Predictive Value (PPV)	95.7²
Negative Predictive Value (NPV)	96.8²
Diagnostic Accuracy	96.3²
Positive Likelihood Ratio (+LR)	32.0⁴
Negative Likelihood Ratio (–LR)	0.04⁴

Clinical relevance

• The Rent Test demonstrates very high sensitivity and specificity, making it one of the most reliable tools for identifying rotator cuff tears.

• A high +LR (32.0) means that a positive test strongly indicates a tear.

• A low –LR (0.04) means that a negative test almost rules out a full-thickness tear.

• Best used as a supplement to other rotator cuff tests to improve diagnostic certainty.

Conclusion

The Rent Test is a highly sensitive and specific clinical examination for detecting rotator cuff tears.

• Positive test: Palpable defect (“sulcus”) in the tendon suggests a full-thickness tear.

• Negative test: Greatly reduces the likelihood of a tear.

• While powerful on its own, it should be combined with other tests for a more comprehensive evaluation of shoulder pathology.

References

1. Moulton SG, Greenspoon JA, Millett PJ, Petri M. Suppl 1: M3: risk factors, pathobiomechanics and physical examination of rotator cuff tears. The open orthopaedics journal. 2016;10:277.

2. Dutton M. Orthopaedic Examination, Evaluation, and Intervention. New York: The McGraw-Hill Companies (2nd Ed.) 2008

3. Clinically Relevant Technologies, http://www.youtube.com/watch?v=YA6oasQWGFA, Accessed May 2011

4. Cleland J. Orthopaedic Clinical Examination: An Evidence-Based Approach for Physical Therapists. Philadelphia; Saunders, Elsevier: 2007

5. Lyons AR & Tomlinson JE. Clinical Diagnosis of Tears of the Rotator Cuff. J Bone Joint Surg. May 1991;(74):404-405