Rotator Cuff Tear - Diagnosis

Diagnosis

Diagnosis is based upon a physical assessment and a detailed history of the patient, including descriptions of previously participated activities and acute or chronic symptoms experienced. The physical examination of a shoulder deals with a systematic approach constituting inspection, palpation, range of motion, strength testing, and neurological testing. The shoulder will be examined to see whether it is tender in any area or whether there is a deformity. Since most cervical pain is commonly mistaken for shoulder pain, the physical examination should include a thorough assessment of the cervical spine in order to eliminate other contradictions such as a "pinched nerve", osteoarthritis or rheumatoid arthritis.

Common medical studies used in diagnosing a rotator cuff tear include X-ray, MRI, double-contrast arthrography, and ultrasound techniques. A normal rotator cuff tear usually goes undetected with an X-ray, although bone spurs, which can pinch the rotator cuff tendons and result in a tear, can be captured. Moreover, if bone spurs are present, it suggests chronic severe rotator cuff disease. Double-contrast arthrography involves injecting contrast dye into the shoulder joint to detect leakage out of the injured rotator cuff. Arthrography and ultrasound are used, but depend heavily on the experience of a radiologist. The most effective and common diagnosis tool is magnetic resonance imaging (MRI), which can sometimes tell how large the tear is, as well as its location within the tendon. Furthermore, MRI enables the detection or exclusion of complete rotator cuff tears with a reasonable accuracy and is also suitable to diagnose further pathologies of the shoulder joint.

The correct use of diagnostic tests is an important component of effective medical practice. X-rays cannot directly reveal tears of the rotator cuff as the tendon is made of soft tissue and not bone. Normal x-rays cannot rule out a torn or damaged rotator cuff. Indirect evidence of rotator cuff pathology can be seen on x-ray in instances where one or more of the tendons have undergone degenerative calcification ( calcific tendinitis). Large tears of the rotator cuff may allow the humeral head to migrate upwards ( high riding humeral head) and this can be seen on x-ray. Prolonged contact between a high riding humeral head and the acromion above it, may lead to x-rays findings of wear on the humeral head and the acromion and secondary degenerative arthritis of the glenohumeral joint(the ball and socket joint of the shoulder) may ensue called cuff arthropathy. Incidental x-ray findings of bone spurs at the adjacent acromio-clavicular joint (A-C joint) may show a bone spur growing from the outer edge of the clavicle downwards towards the rotator cuff. Bone spurs may also be seen on the underside of the acromion. These types of bone spurs were thought to cause direct fraying of the rotator cuff from contact friction, a concept currently in controversy.