The most common symptoms of a rotator cuff tear are pain and weakness of the shoulder. The pain may be constant, or felt only when reaching or attempting to raise the arm overhead or lift something above shoulder level. Sometimes, particularly with a complete tear of the rotator cuff, one may hardly be able to lift the arm from one's side.
People with rotator cuff tears often experience pain at night because sleeping in certain positions puts pressure on the shoulder. In some people, the injured shoulder makes popping or clicking sounds when moved. For others, the shoulder seems to stick momentarily.
Thus, some people with just a small tear or a partial thickness tear of the rotator cuff may experience marked pain while others with a large tear or full thickness tear may experience little pain. Commonly though a large tear is more painful. But not uncommonly a partial thickness tear may be more painful than a full thickness tear.
Q: Are there any early warning signs of a rotator cuff tear?
A: Many people experience weakness, pain, swelling, and/or stiffness in the shoulder long before the rotator cuff actually tears. That's because, while some rotator cuff tears happen suddenly as a result of a fall or injury, most develop gradually, as a result of wear-and-tear on the rotator cuff.
If these early warning signs are heeded, specific steps can be taken to attempt to resolve the symptoms without surgery. That's why it's important to see a doctor if you suffer pain in the shoulder or are unable to properly use the shoulder.
How are Rotator Cuff Tears Diagnosed?
Physicians use a variety of tests to diagnose and evaluate the severity of a rotator cuff tear. These include:
Physical examination X-ray Magnetic resonance imaging (MRI) Ultrasound
The doctor will (and should) do the following:
Inspect the shoulder for tenderness, muscle wasting, swelling and the general contour of the shoulder. Assess range of motion of the shoulder and at what height the pain commences Look for signs of weakness, instability, and pain during specific movements. Some of these simple tests are designed to figure out whether the rotator cuff is being pinched between the upper arm bone and the acromion (impingement). Assess the strength of resisted movements of the shoulder and if these type of movements are painful Possibly inject an anesthetic, or painkiller, into the injured shoulder in an attempt to localize the problem (is the pain coming from the rotator cuff or possibly from another area of the shoulder). The degree of pain relief or change in movement after the injection may help determine the nature of the problem.
X-ray: Because x-rays do not show soft tissue such as tendons, they cannot show whether or not the rotator cuff is torn. X-rays are used to rule out other causes of shoulder pain, particularly arthritis (osteo or degenerative arthritis) of the nearby acromio-clavicular joint which may be a contributory cause to the shoulder pain or even a contributory cause to the tear of the rotator cuff. Degenerative arthritis affecting the acromio-clavicular joint can result in formation of bone spurs which can irritate the underlying rotator cuff.
The x-ray can also show whether the space between the humerus (arm bone) and the acromion has narrowed, which would suggest that the rotator cuff is not functioning normally (maintaining downward pressure on the humerus). X-rays can also reveal the presence of calcium deposits, bone spurs, or previous fractures. In longstanding severe rotator cuff tears the x-ray may show advanced degenerative changes of the main shoulder joint with the head of the humerus 'riding high' (because of the loss of the normal depressor function of the rotator cuff).
Magnetic Resonance Imaging (MRI): Magnetic resonance imaging (MRI) scan is one of the most powerful diagnostic tools available to doctors. An MRI scan uses magnetic waves and computers to create detailed images of the interior of the shoulder. An MRI can reveal even small, partial tears of the rotator cuff. An MRI is painless and has, for the most part, replaced the arthrogram for the diagnosis of rotator cuff tears.
Sometimes the physician may opt to inject dye into the shoulder joint before doing the MRI scan. This is called an MRI arthrogram. One will get better pictures and learn a lot more about the shoulder joint (if there is a tear the dye will be seen leaking through the tear). An MRI arthrogram is commonly used to determine if there is a tear of the labrum (another soft tissue in the shoulder related to the stability of the shoulder joint) rather than to investigate rotator cuff tears.
Ultrasound: Ultrasound tests use sound waves to examine the inside of the shoulder. This is now commonly used to diagnose a tear of the rotator cuff. It is not as sensitive or as reliable as an MRI scan.
An ultrasound scanner emits harmless waves; the returning echoes are recorded by a computer which produces an image of the part of the body scanned.
For more information about ultrasound, go to Ultrasound.