What is the Best way to Diagnose my Rotator Cuff Tear?

The rotator cuff is a group of tendons that connects the four rotator cuff muscles to the arm bone.The tendons run under the acromion, a portion of the shoulder blade, where they are often damaged, leading to a tear. When the tendons or muscles of the rotator cuff tear, the patient is not able to lift or rotate their arm as much as before the injury. There is pain with shoulder movement, is very common at night, and often goes down the arm. A tear can also happen as the result of a deformity in the shoulder. This is often caused by an Impingement of the tendons by a hooked acromion.

There are three tests one can use to help diagnose a Rotator Cuff Tear.Radiography – X/R, Ultrasonic Scan and Magnetic resonance imaging.

Rotator Cuff Radiography this is the quickest and least expensive test for Rotator Cuff Tears and is for looking at boney abnormalities.

Impingement Radiographic Series:

Axillary view: may reveal an Os Acromiale, a loose or mobile acromion that can be associated with an impingement or the rotator cuff tendons.

Scapular outlet view: used to evaluate the subacromial space and the Supraspinatus outlet from lateral view to show a possible rotator cuff impingement.

Type 1, a flat acromion 3% of all cuff tears have this type of acromion;

Type 2, a curved acromion 27% of all cuff tears have this type of acromion;

Type 3, a hooked acromion a majority (70 - 90%) of rotator cuff tears may be seen in pts w/ type-2 or a type-3 acromion.

Rotator Cuff Radiography above shows a type 3.

AP view of the Shoulder is helpful looking for calcific tendinitis in the Supraspinatus, also to reveal any degenerative changes;

Active Abduction View: could be used for detection complete Rotator cuff tears.

West Point View: could be indicated in younger patients with suspected anterior instability; useful in identifying anterior glenoid abnormalities, Bankart Lesion, indicating traumatic instability of the shoulder.

However a rotator cuff tear is best diagnosed with a scan. The type of scan depends on finance and skills.

Ultrasound Scan - in some cases this can be done immediately in the clinic and is accurate, dynamic and cost effective.

MRI Scan - This is more costly and less accessible, but can provide information on the quality of the muscles and other underlying structures of the shoulder.

Ultrasound Scan

Ultrasound tests use sound waves to examine the inside of the shoulder. They are good to diagnose rotator cuff injuries. In ultrasound, a hand-held instrument that emits sounds and detects returning echoes is passed over the skin of the shoulder. A computer records these echoes and produces an image of the inner body.

This is accurate, dynamic and cost effective.

Magnetic resonance imaging – MRI.

These create a more thorough investigation. It shows soft tissue, bone and fluid. So is good for use looking at the rotator cuff. A rotator cuff MRI is extremely beneficial as most of these injuries happen in the tendons. An MRI can reveal even small, partial tears of the rotator cuff.

A rotator cuff MRI allows the orthopedic surgeon see exactly the problem

Notice white signal within black signal at the tip of the red arrow.

MRI’s are more costly and less accessible, but provide great information on the quality of the structures of the shoulder.

Which Test for Rotator Cuff Injuries?

To start, use an X/R to see if there are any boney abnormalities.

I would then use an US Scan because of its lower cost and is readily available.

If the US Scan is unclear then go to the expensive MRI.