Rotator Cuff Injury (cont.)
Rotator Cuff Injury Diagnosis
The care provider may want to take a thorough history of the acute injury as well as any previous symptoms that may suggest a more long-term problem.
The physical examination often involves observation to look for deformities, muscle wasting, and changes in the appearance of the damaged shoulder compared to the normal one.
Palpation means touching, including feeling the bones that make up the shoulder joint. These include the clavicle (collarbone), scapula (shoulder blade), and humerus (upper arm bone). The muscles of the shoulder may be palpated, trying to find areas of tenderness or pain.
- Evaluation may include the assessment of range of motion of both shoulders. This may be done both passively (as you sit down or lie on your back and the examiner gently moves the arm in all directions) and actively (the patient moves the arm as far as possible in all directions). This part of the examination may be delayed or not done if a broken bone is suspected. The power of the shoulder muscles can also be assessed this way depending upon whether the patient can move the shoulder against resistance or perhaps just lift the arm up against gravity.
- Sensation and blood flow in the arm and hand may be assessed, feeling for pulses and determining if there is normal light touch, pain, and vibration sensation in the extremity.
- The neck may also be examined, depending on the age of the person, cause of injury, and symptoms to make certain that the pain in the shoulder is not referred pain from conditions of the cervical spine.
- The care provider may ask about chest pains or trouble breathing to make certain that the shoulder pain is not referred from the heart.
- A variety of tests may be performed to try to decide which of the four muscles of the rotator cuff is injured or damaged. Each uses muscle contractions to try to find the weak or painful muscle. Examples include the Jobe test for the supraspinatus muscle, the Patte test for the infraspinatus and teres minor muscles, and the Gerber test for the subscapularis muscle.
Plain X-rays are usually taken as a screening exam to look for broken bones or arthritis within the shoulder joint. Sometimes, calcification can be seen along the tendon. Often, the X-ray findings are normal in rotator cuff injury.
Advanced imaging studies
- Magnetic resonance imaging: The MRI has become the test of choice for most significant shoulder injuries. This test is able to identify all the structures that make up the rotator cuff and can identify degeneration changes to partial or complete tears of the tendons and muscles, or a combination of all these conditions.
- Arthrography: Dye is injected into the shoulder joint to look for complete rotator cuff tears and is usually combined with computerized tomography. The test is less helpful in revealing partial tears or tendinitis.
- Ultrasonography: This is a sound wave test that can help evaluate damaged tendons and muscles but has difficulty in assessing the bones of the shoulder. The benefit of ultrasound is that it can be done as the shoulder is moved and can find places where the rotator cuff is being pinched or impinged upon. However, the quality of ultrasound depends upon the skill and experience of the ultrasound technician and radiologist.
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