Exams and Tests

To diagnose a rotator cuff disorder, your doctor will ask about your injury or shoulder pain history and will do a physical exam to see how your shoulder is working.

If your symptoms and exam show that you may have a complete rotator cuff tear, you may have one or more of these tests to confirm the diagnosis:

• X-ray
• MRI
• Ultrasound
• Arthrogram (rare)

Further testing

Your age, job, and activity level are considered when your doctor is deciding about further testing. For example, if you are a competitive athlete or have a job that requires frequent overhead activity, you may need further testing sooner than a relatively inactive older adult. A more complete diagnosis is important if you are likely to continue activities that may further damage your shoulder.

Treatment Overview

Treatment of rotator cuff disorders should begin soon after an injury or soon after symptoms develop, to give you the best chance of restoring flexibility and strength to your shoulder. Without treatment, inflammation and tears can build up, causing pain, weakness, and loss of function.

Treatment depends on your symptoms, age, and activity level, and on whether your symptoms appear to be related to a rotator cuff injury.

Nonsurgical treatment

Most rotator cuff disorders are treated without surgery. Your treatment may include:

• Medicines. For more information, see Medications.
• Home treatment, such as rest and applying cold or heat. For more information, see Home Treatment.
• Physical therapy. For more information, see Other Treatment.

If symptoms don't improve after a few months of nonsurgical treatment, you and your doctor may consider testing (such as X-rays or an MRI) to find out if you have a rotator cuff tear.

Or your doctor may give you a corticosteroid shot.

Surgery

Surgery often is used to repair a torn rotator cuff in a healthy young person, because good results are more likely if there is little or no evidence of degeneration or impingement.

People who have advanced rotator cuff disorders and tendons that are tough, stringy (fibrous), and stiff usually respond less well to surgery. Surgery may successfully repair the tear, but it can't repair all the damage caused by age or degeneration.

But surgery may be considered if:

• You have a rotator cuff tear caused by a sudden injury.
• Your shoulder doesn't get better after 3 to 6 months of other treatment.

For more information, see Surgery.

What to think about

Recovery from a rotator cuff disorder varies with each person. Your physical therapy and home exercise program should continue until your shoulder is as strong and flexible as possible. Some treatments for rotator cuff disorders can last up to a year. Most people can return to their previous activities after several weeks of rehabilitation.

Experts have differing opinions about treating rotator cuff tears.

• Some prefer nonsurgical treatment for people older than 60. But other experts believe that the sooner a rotator cuff tear is surgically repaired, the better the chance of a successful outcome, regardless of age.
• Some believe that small tears do not need surgery. Other experts feel that small tears should be repaired early to prevent further tearing.