If the injury is an incomplete, or partial, tear, pain will likely be the most prominent symptom; decreased strength may be demonstrated, but is usually not the patient's primary complaint. However, in a complete rotator cuff tear, the patient will likely be unable to move the shoulder through some normal motions. The diagnosis of a rotator cuff tear is best made by a physical examination where your doctor can isolate and test the function of the specific muscles that form the rotator cuff.
The most common symptoms of rotator cuff tears are:
- Pain
Often the pain is felt over the outside of the shoulder and upper arm. Pain while performing overhead activities (with the arm above head height) and pain at night are also quite common. When the condition is more severe, the pain may awaken patients from sleep. - Decreased strength
Strength of the rotator cuff tendons can be tested by your doctor. By isolating the different tendons of the rotator cuff with special tests, your doctor can determine the extent of the tear. Significant rotator cuff tears may affect a patients ability to raise up their arm over their head. - Difficulty with specific activities
Patients often complain of difficulty performing activities such as combing their hair, clasping a bra behind their back, reaching behind their back, or sleeping on the affected shoulder.
X-rays of the shoulder will be obtained if there is a concern of a rotator cuff tear. Your doctor will look for signs of a rotator cuff tear, although the rotator cuff tear itself cannot be seen on a regular x-ray. Signs of a problem within the rotator cuff include a narrowing of the space for the rotator cuff and bone spurs around the rotator cuff tendons.
The test most commonly used to diagnose a rotator cuff tear is a MRI, but this is not the only way to diagnose a rotator cuff tear. The following tests can all be used to make the diagnosis of a rotator cuff tear:
- MRI
A MRI is the most commonly used test to confirm a diagnosis of a rotator cuff tear. The MRI is helpful because it can show both complete rotator cuff tears and partial rotator cuff tears. The MRI can also show evidence of shoulder bursitis and other common shoulder problems. - Arthrogram
An arthrogram once was the most commonly used test to diagnose a rotator cuff tear. In this study a dye that shows up on x-ray is injected into the shoulder joint. An intact rotator cuff should contain the dye within the joint, while a rotator cuff tear will allow the dye to leak into surrounding tissues. By taking an x-ray after an injection, your doctor can see evidence of a rotator cuff tear. - Ultrasound
New studies now show that an ultrasound, operated by a skilled technician, can be as effective detecting a rotator cuff tear as these other methods. Depending on your doctor's preference, you may undergo an ultrasound study to diagnose a rotator cuff tear.
Rotator cuff tears are extremely common, but there are several other common causes of shoulder pain. Patients with shoulder pain will also be evaluated for other causes of shoulder pain before settling in on the diagnosis of a rotator cuff tear.
Patients may also be told they have a partial rotator cuff tear. This means that the tendon of the rotator cuff is not completely torn, but there is damage to the tissue that is causing symptoms. Treatment for a partial rotator cuff tear is similar to a complete rotator cuff tear.
