How Are Rotator Cuff Problems Diagnosed?

Physicians use a variety of tests to diagnose and evaluate the severity of rotator cuff problems. These include:

• Physical examination

• X-rays

• Arthrogram

• Magnetic resonance imaging (MRI)

• Ultrasound

• Diagnostic arthroscopy

Physical Examination, Including Impingement Test

A physician begins with a thorough physical examination of the injured shoulder:

• One of the first things the physician does is test the shoulder's range of motion to see how much it can move.

• The physician looks for signs of weakness, instability, and pain during specific exercises. Some of these simple tests are designed to figure out whether the rotator cuff is being pinched between the upper arm bone and the acromion (impingement).

• Often the physician will inject an anesthetic, or painkiller, into the injured shoulder to localize the problem to the rotator cuff. The degree of pain relief or change in movement after the injection will help determine the nature of the problem.

X-rays

Because x-rays do not show soft tissue such as tendons, they will not expose a partially or completely torn rotator cuff. X-rays are used to rule out other causes of shoulder pain, such as a fracture or dislocation.

They can also show whether the space between the arm bone and the acromion has narrowed, possibly resulting in impingement, and whether there are abnormalities in the acromion. X-rays can also reveal the presence of calcium deposits, bone spurs, or arthritis.

Arthrogram

For an arthrogram, a small amount of special dye is injected into the affected shoulder joint, then x-rays are taken. Because this dye can be seen in x-rays, an arthrogram can help a physician to figure out whether the rotator cuff has been torn.

Magnetic Resonance Imaging (MRI)

A magnetic resonance imaging (MRI) scan is one of the most powerful diagnostic tools available to doctors. An MRI scan uses magnetic waves and computers to create detailed images of the interior of the shoulder. An MRI can reveal even small, partial tears of the rotator cuff. An MRI is painless and has, for the most part, replaced the arthrogram for the diagnosis of rotator cuff tears.

For more information about MRI, go to MRI.

Ultrasound

Ultrasound tests use sound waves to examine the inside of the shoulder. Though less commonly performed than other tests, they are also sometimes used to diagnose rotator cuff injuries.

In ultrasound, a hand-held instrument that emits sounds and detects returning echoes is passed over the skin of the shoulder. A computer records these echoes and produces an image of the inner body.

For more information about ultrasound, go to Ultrasound.

Diagnostic Arthroscopy

During arthroscopy, a physician makes a small cut in the shoulder, then inserts a thin tube that contains a miniature video camera. This camera allows the physician to see whether the rotator cuff has been torn. During this procedure, a person receives either local anesthesia (to numb the area) or general anesthesia (to sleep through the procedure).

For more information about arthroscopy, go to Arthroscopy Of The Shoulder.