Your orthopedic surgeon or physician will be able to assess, test and diagnose your rotator cuff injury through a variety of processes.
History of the Injury
To begin with, they will gather a medical history about you and your current condition and symptoms. They will inquire about the intensity of your present pain, the duration of your symptoms and the limitations you are experiencing. Details about what instigated the problem, when it started, and whether or not you have ever had treatments for this or a similar condition in the past, are very helpful in assessing your injury.
A physical examination will be performed to determine if you have any signs of a rotator cuff or other shoulder injury. Your doctor will visually assess and palpate (feel) the bones and soft tissue in both your shoulders to evaluate symmetry and recognize differences. This will identify any abnormalities, such as mild or severe inflammation, bone deformity, atrophied muscles, redness and/or warmth on the skin.
Range of Motion Tests
You will generally be asked to complete a series of movements to measure your active (performed by you) and passive (performed by your examiner) range of motion. These will test any possible shoulder impingements, as well as your shoulder strength, joint stability, and location of tenderness.
If you are experiencing rotator cuff tendonitis, you will generally feel pain and weakness when the arm is lifted in front of the body or overhead. Often all that will be required to determine your condition is a discussion of your medical history, as well as a visual and physical examination of your shoulder. You may be asked to perform a few movement tests to identify which areas of the Rotator Cuff are damaged, such as the following:
To test strength in your supraspinatus tendon and muscle, hold your arms out in front of you at a 30 degree angle with your elbows locked and your thumbs pointing down. Gentle pressure will be applied to the top of your arms as you try to move your arms up and away from your body.
To test if you have a shoulder impingement you may be asked to raise your arm overhead, lock your elbow, and rotate your arm inward so your thumb is pointing down; pain with movement is a key indicator.
A rotator cuff tear will be evident after determining your limited range of motion and the weakness in your muscles; with a tear you will often not be able to complete the movement tests as a result of the pain. An X-ray will generally be taken to help explain other possible sources of the shoulder pain. Occasionally an MRI will be recommended which will identify the degree of specific tissue tears, swelling, and fluid in the rotator cuff.
If you have experienced shoulder instability pay special attention to your symptoms. A shoulder subluxation can usually be diagnosed with a physical exam and some movement tests which identify pain or weakness. A dislocation will probably require an x-ray and/or a MRI to assess the overall damage.
Rotator Cuff Diagnostic Tests
A medical professional will sometimes recommend diagnostic testing to obtain more detailed information about your shoulder condition. There are a variety of different tests available to help them analyze the situation; however these will be dependent on your injury.
X-rays provide an image of the overall structure of the shoulder, and are helpful in identifying abnormal bone shapes and/or spurs, arthritis, or calcific tendonitis.
MRIs will show soft tissue and provide more detailed information to evaluate soft tissue (muscle, tendons, ligaments, connective tissue) injuries such as fluid in the shoulder, bursitis, tendoniti, and/or tears.
CT or CAT Scan
This will be used to provide a more thorough assessment of the bones and tissues in your rotator cuff and shoulder.
Further diagnostic tests such as an arthrogram, ultrasound, electromyogram, or arthroscopic surgery can be used to determine the degree and location of your injury if required.
Other areas near the source of discomfort, such as your neck, may be examined to ensure your pain is not coming from a “pinched nerve” in the cervical spine, or to rule out osteoarthritis or rheumatoid arthritis.