Exams and Tests

History

The doctor will take a thorough medical history to determine the possible cause and note immediate symptoms as well as any previous symptoms that may suggest a more long-term problem.

Physical exam

• The doctor will look at and compare both shoulders, which requires you to be partially undressed.



• The exam will continue with careful touching of the entire shoulder. The examiner may begin this touching at the center of the chest with the breastbone and follow the collarbone in the direction of the injured shoulder. Throughout the exam, the doctor is taking note of all areas of tenderness or deformity.



• The doctor will often continue by evaluating both shoulders' range of motion. This may be done both passively (as you lie on your back, the examiner gently moves the arm in all directions) and actively (you sit up and move 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 physical exam also involves evaluation of sensation in the arm, as well as the blood flow to the entire arm. Some physicians do this first because it is so important. The physician may choose to evaluate the neck depending on the age of the person, cause of injury, and symptoms.



• Don't be surprised if the doctor asks you about chest pains or trouble breathing as it is important to make sure the pain is from the shoulder and not from the heart or elsewhere.

Tests

• Impingement injection test: Standing behind you with one hand on your shoulder blade, the physician will raise your arm forward. The test result is considered positive if it causes pain in the muscle (impingement sign). The physician will now inject lidocaine (a numbing medicine) beneath the top part of the shoulder blade (acromion) and then repeat the test for signs of impingement. If you have no pain now with movement of the arm, it is likely the pain is due to tendinitis or possibly a small tear of the rotator cuff.



• Drop arm test: The examiner will raise the injured arm 90° out to the side and have you hold the arm in that position. The physician will then apply a slight pressure to the forearm or wrist. This action may cause you to suddenly drop the arm. If this occurs, it is often a sign of a significant tear of the rotator cuff.

X-rays

These are usually taken to determine whether there are any broken bones. Most often, the x-ray findings are normal in rotator cuff injury.

Advanced imaging studies

These are usually not performed unless rotator cuff injuries do not improve after a period of proper care.

• Magnetic resonance imaging: The MRI has become the test of choice for most severe shoulder injuries. This test is able to identify all rotator cuff injuries from degeneration to partial or complete tears.



• Arthrography: This is done with injection of a dye into the shoulder joint. It is an excellent test for diagnosing a complete tear, which is seen as an opening in the joint. Partial tears are more difficult to evaluate, particularly in people older than 40 years of age.



• Ultrasonography: This is a sound wave test that is safe, easy to perform, and offers comparison with the uninjured shoulder. Tears are noted by the absence of normal echoes of the sound waves in the area of the tendon.