Diagnosing a Rotator Cuff Tear

The rotator cuff is a group of muscles that help to rotate the shoulder and control the shoulder’s stability. The most commonly injured tendon is the supraspinatus, which tends to get tendonosis or tendonitis. This tendon within the rotator cuff is the one that’s most commonly torn.

Injuries to the rotator cuff don’t usually happen to people younger than 40 years old, but sports and other similar activities may cause a rotator cuff injury to younger individuals. The most common people to get these tears are typically 50 to 60 years old who present with symptoms like pain and weakness. The most significant pain is usually reaching overhead or reaching towards something like, reaching into the backseat of the car, reaching backwards.

In most cases of rotator cuff tears, there isn’t a significant amount of swelling noted in the shoulder, but patients do have weakness and pain could be anywhere that ranges from mild to severe.

I can get over 80 percent of people better without surgery, just by using physical therapy.

– Dr. Rick Weinstein on Rotator Cuff Injuries

How to Diagnose a Rotator Cuff Tear

If someone tears a rotator cuff or, I suspect they have a rotator cuff tear, I usually can diagnose if it’s torn or not through the physical exam.

But, like other parts of the body, a good orthopedic sports doctor can diagnose it, but we confirm our diagnosis with an MRI.

In my office, we actually use ultrasound to help diagnose rotator cuff tears, but we can also inject the shoulder with dye to better see what’s going inside your shoulder during the ultrasound. In some cases, if someone has a rotator cuff tear and they’re under 70 years old and active, we typically recommend a rotator cuff repair.

Rotator cuff repair typically takes me about 45 minutes to an hour. Patients go home the same day remain pain-free for up to 24 hours after the surgery due to the anesthesia that’s used. Right after the surgery, we do try and get the patients to move the arm, using their other arm, but maintain use of a sling for a couple of weeks.

We don’t want to get what’s called a “frozen shoulder,” or stiff shoulder, so patients are encouraged to move their arm right away, if possible.

How a Torn Rotator Cuff Occurs

Sometimes people lift something, pull something or, fall onto the arm and have sudden pain and weakness and they don’t know that they really hurt their shoulder.

Other times, people just wear through a part of their rotator cuff and may not really have a traumatic episode where they say, “Oh, that’s when I hurt it.” Sometimes, someone may be walking around with a tear for anywhere from a couple of weeks to a couple of months and not even realize that their rotator cuff is torn

Many people get injured while traveling on vacation because they’re carrying heavy luggage or they suddenly grab something heavier than they should. Moving heavy objects is another instance where a lot of people get injured even within in their home.

In terms of sports, the overhead activity sports such as tennis can really put a stress on the shoulder and possibly tear the rotator cuff. This type of injury is not infrequent. Many golfers injure their shoulder, but wait to come in at the end of the season to get a check because they don’t want to miss any golf despite the recommendation to seek medical assistance as soon as possible.

Upon physical examination, I can tell whether the rotator cuff is torn or not. During my examination, I perform a certain test with patients that will tell me there’s real weakness (which needs to get an MRI) or if it’s just a mild weakness and I don’t think it’s a tear. In most cases, 80 percent of people can get better without surgery by using physical therapy.

Physical Therapy for a Rotator Cuff

Most people after the tendonitis come back and see me in four weeks and they are usually better at that point. If they’re not 100 percent, they may do another round of four more weeks of therapy. And if they’re still not better after that and there’s no tear, we go in and do an arthroscopy, which is about a 15 to 20-minute procedure, clean out the inflammation and the bone that’s rubbing against the rotator cuff and they go back to activities pretty quickly.

 

Make an appointment with Westchester Sport and Spine if you’re experiencing weakness in the shoulder and suspect that you might have a rotator cuff tear.

Dr. Rick Weinstein, MD, MBA is an orthopedic surgeon specializing in sports medicine. He is the Director of Orthopedic Surgery at Westchester Health Associates and has subspecialty training in knee and shoulder surgery, including minimally invasive surgery and arthroscopy. Dr. Weinstein is a Board Examiner for the American Board of Orthopedic Surgeons, determining certification for other orthopedic surgeons.