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A 59 year-old male presented to the county emergency department (ED) in southeastern United States for evaluation of a progressively worsening lump on his left shoulder. He describes it as painful and suggests "it might be a tumor". There were no other associated complaints. On physical examination, there was a firm, non-tender, non-mobile mass without erythema or warmth, superior to the patient's left acromioclavicular (AC) joint. Both hawkins and empty can test were positive for pain. Point-of-care ultrasound identified a fluid filled structure overlying the AC joint. Initial radiographs demonstrated the so-called geyser sign, a finding of synovial fluid expressed through the AC joint consistent with rotator cuff tear. Subsequent CT scan identified atrophy of the supraspinatus muscle most consistent with rotator cuff tear. This case represents a unique presentation of a chronic rotator cuff tear., Competing Interests: The authors declare no conflicts of interest., (© 2020 African Federation for Emergency Medicine. Publishing services provided by Elsevier.)