X-rays. Although a rotator cuff tear won't show up on an X-ray, this test can visualize bone spurs or other potential causes for your pain — such as arthritis. Ultrasound. This type of test uses sound waves to produce images of structures within your body, particularly soft tissues such as muscles and tendons.
This rubbing against the tendon is called rotator cuff impingement. Impingement can be diagnosed without an imaging test, by the physical exam of an experienced doctor, but can also be directly diagnosed on live ultrasound while moving your arm.
The drop arm test is used to assess for full thickness rotator cuff tears, particularly of the supraspinatus. This can be useful when diagnosing sub-acromial pain syndrome (shoulder impingment) or to differentiate between shoulder and rotator cuff pathologies.
The pain associated with a rotator cuff injury may: Be described as a dull ache deep in the shoulder. Disturb sleep. Make it difficult to comb your hair or reach behind your back.
Rotator cuff tendon tears often cause pain at night. The pain may even wake you. During the day, the pain is more tolerable, and usually only hurts with certain movements, such as overhead or reaching toward the back. Over time, the symptoms become much worse and are not relieved by medicines, rest, or exercise.
But any inflammation or partial or full tear can make performing daily activities very painful. Symptoms of a rotator cuff injury may include: Pain or tenderness when reaching overhead. Pain or tenderness when the arm is at rest.
Patients are often advised to wear a sling or brace for the first 4–6 weeks after rotator cuff repair surgery to prevent them from performing any physical activities involving the affected shoulder (3).
The most common symptoms of a rotator cuff tear include: Pain at rest and at night, particularly if lying on the affected shoulder. Pain when lifting and lowering your arm or with specific movements. Weakness when lifting or rotating your arm.
Typically, you will feel pain in the front of your shoulder that radiates down the side of your arm. It may be present with overhead activities such as lifting or reaching (e.g., serving in tennis, painting a ceiling). You may feel pain when you try to sleep on the affected side.
The main symptom of a torn rotator cuff is pain. If the tear happens suddenly, the pain will start immediately and be severe. You may also feel a pop or a snapping sensation with immediate weakness. If the tear develops over time, the pain can be mild and gradually get worse.
MRI has been the gold standard for visualizing rotator cuff injuries because it provides a detailed, cross-sectional view of the shoulder that ultrasound cannot provide. However, MRI does not allow the doctor to observe soft tissue changes during shoulder movement.
The consensus is that ultrasound rivals an MRI when looking for tears of tendons, full and partial thickness, as well as for inflammation and swelling.
A recent meta-analysis reported that on present level of knowledge MRI has the best sensitivity and comparable specificity for the detection of full- and partial-thickness tears of the rotator cuff.
MRI and US Diagnostic Accuracy in Primary Rotator Cuff Tears
MRI and ultrasound (US) have classically been accurate tools for detecting primary full thickness tears.
Usually, mild rotator cuff tears or sprains will heal within four weeks. In other severe cases, the recovery might take 4 to 6 months or even longer based on several factors such as the severity of the tear, age, and other health complications.
There are a few key differences between a rotator cuff strain and tear. A rotator cuff strain is a stretching or micro-tearing of the tendons and muscles surrounding the shoulder joint while a tear is a complete or partial tearing of one or more of the tendons in the shoulder.
Tearing and injury to the rotator cuff become more likely as tendons in the shoulder naturally wear down over time. Due to gravity, laying down can cause the rotator cuff to stretch and pull, leading to significantly worsened pain at night.
During the recovery phase of a rotator cuff injury, avoiding overhead lifts with any weight is highly recommended. Movements that require the shoulders to be put under intense pressure or performing complex motions will put more strain on the muscles and potentially cause more significant injury.
The symptoms are usually aggravated by raising the arms overhead or in activities that require reaching behind the body, such as retrieving an object from the back seat of a car. Furthermore, reaching behind the back to fasten underclothing or to pass a belt may aggravate the arm and shoulder pain.
Red flags include: Trauma, pain and weakness, or sudden loss of ability to actively raise the arm (with or without trauma): suspect acute rotator cuff tear. Any shoulder mass or swelling: suspect malignancy. Red skin, painful joint, fever, or the person is systemically unwell: suspect septic arthritis.
If left untreated, a rotator cuff tear can severely restrict function and range of motion. The tear can also increase over time. This may cause partial rotator cuff tears to progress to total tears.