How is a Rotator Cuff Injury Diagnosed?
DiagnosisA medical professional will need to conduct a physical examination to diagnose a rotator cuff injury. Your appointment will begin with a discussion of your symptoms and medical history. Next, your doctor will thoroughly examine your arm and shoulder by pressing on various parts to check for tenderness or irregularity.
Your arm will then be moved in various directions and positions to measure the range of motion of your shoulder. Finally, the strength of your shoulder and arm muscles will be tested.
Your doctor will also check the shoulder joint for any other problems, such as arthritis, and will check your neck to ensure that your pain and other symptoms are not the result of a pinched nerve.
Additionally, your doctor may order the following imaging tests to assist with making a diagnosis:
- X-Rays - Usually the first imaging test performed for rotator cuff diagnosis. X-rays show only bone, so they will not show the rotator cuff or other soft tissues. Doctors use these images to check for additional conditions that may be present in the shoulder, such as arthritis or bone spurs.
- Magnetic Resonance Imaging (MRI) - This medical imaging technique uses a magnetic field and radio waves to create detailed images of the body's soft tissues, including the rotator cuff. It can show both partial and complete rotator cuff tears when they are present, as well as their size. Doctors can also use these images to determine whether a rotator cuff tear is older or newer since the images will show the overall condition of the rotator cuff muscles.
- Ultrasound -This medical imaging technique is used less frequently for rotator cuff tear diagnosis, as MRI is the preferred technique. Ultrasound uses sound waves to create images of internal body structures, specifically soft tissues, including the rotator cuff. This type of imaging allows for real-time testing, allowing doctors to examine the various parts of the shoulder as they move. It can also enable doctors to compare the affected and the healthy shoulders.
How is a Rotator Cuff Injury/Tear Treated?
TreatmentsIgnoring the symptoms and pain of a rotator cuff injury and using the shoulder regularly may cause further and more severe damage. The best way to keep the injury from getting worse is to start treatment when your symptoms start.
About 80% of patients with rotator cuff injuries experience decreased pain and increased functioning with nonsurgical treatment, which may include rest, ice, modifying activities, and physical therapy.
A steroid injection may also help when other treatments aren't enough. If your symptoms do not improve in six to twelve months, or if you have significant weakness or loss of function, your doctor may recommend surgery.
Injections
Injections for treating rotator cuff injuries are used when rest, other medications, and physical therapy don’t relieve pain effectively. These injections are composed of a local anesthetic and a corticosteroid. Cortisone, a highly effective anti-inflammatory medicine, is often used in injections. Anti-inflammatory injections are often beneficial but offer only temporary relief. Injections must be used with care as they can lead to the weakening of the tendon. They may also lower the success of surgery, should it become necessary.
Therapy
Physical therapy for strengthening and restoring movement is often among the first treatments suggested for rotator cuff injuries. During treatment, patients will be guided through a program that includes stretches and strengthening exercises.
Stretches are designed to improve flexibility and range of motion while strengthening the muscles surrounding the shoulder can help relieve pain. Strengthening exercises can also help to prevent further injury as these surrounding muscles provide greater support to the injured areas. Patients can often continue physical therapy programs at home, increasing their effectiveness.
Surgery
Your doctor may suggest surgery if your rotator cuff injury is a complete tear, or when the pain from a partial tear continues despite less invasive interventions. This is especially true in cases where patients are highly active or use their arms for overhead work.
Most rotator cuff surgeries are outpatient procedures and take place arthroscopically, allowing patients to go home the same day. Overall, recovery from these procedures is lengthy, often taking up to a year or more for a full recovery.
There are options for repairing rotator cuff tears, with the type of repair performed depending on multiple factors. Your doctor will consider factors such as the size of the tear, your anatomy, and the condition of the tendon tissue and bone when choosing the right procedure for you. Types of procedures to repair the rotator cuff include:
- Arthroscopic tendon repair - During this procedure, a small camera called an arthroscope, is inserted through a small incision in the shoulder. Tiny instruments are inserted into additional small incisions in the shoulder and used to remove any bone spurs and reattach the completely torn rotator cuff tendon to the bone.
- Open tendon repair - Depending on the surgeon's preference, they may recommend an open tendon repair. This procedure uses a traditional surgical incision, allowing your surgeon to work directly on reattaching the damaged tendon to the upper arm bone.
- Tendon transfer - When the tear in a rotator cuff is not reparable, a tendon transfer may be a good option. During this extensive procedure, the tendon and its muscle are moved from one location to another to help restore lost movement and stability.
- Shoulder replacement - When rotator cuff injuries result in damage to cartilage and bones in the shoulder joint, then a reverse total shoulder replacement or partial shoulder replacement, also known as hemiarthroplasty, surgery can be done to relieve pain and other symptoms.
- With a reverse total shoulder replacement, the ball and socket are replaced. The placement of the implants is reversed, resulting in the ball being attached to the shoulder blade and the socket being attached to the upper arm bone. This type of replacement is often used when the rotator cuff is severely damaged.
- In a partial shoulder replacement, also known as hemiarthroplasty, only the ball of the joint is replaced. This type of procedure is often used when only the ball side of the joint is damaged, or when the socket bone is too eroded from arthritis to allow for implantation of a reverse replacement on the socket side.
FAQs
Trust NewYork-Presbyterian for Rotator Cuff Injury Care
Treatment for your rotator cuff injury starts with an appointment to see an orthopedic surgery specialist. Understanding the cause of your symptoms and the many treatment options available is the first step on the road to easing pain, getting back to normal activities, and preventing further injury.
Most patients with a rotator cuff injury experience relief through nonsurgical treatments. The professionals at NewYork-Presbyterian will work with you to find the most effective treatment plan to relieve your pain and get you back to the activities you love.