From the Guidelines
To test for a rotator cuff injury, magnetic resonance imaging (MRI), magnetic resonance angiography (MRA), and ultrasonography are the most useful adjuncts to a clinical examination, as supported by strong evidence. The diagnosis of rotator cuff injuries typically involves a combination of physical examination maneuvers and medical imaging. The most common physical examination tests include the Empty Can Test (Jobe Test), the Hawkins-Kennedy Test, the Drop Arm Test, and the External Rotation Lag Sign, which can suggest rotator cuff pathology if pain or weakness is present 1.
Key Diagnostic Tools
- MRI: Provides detailed images of the rotator cuff and surrounding tissues, making it an excellent choice for diagnosing tears and other pathologies.
- MRA: Useful for evaluating the blood supply to the rotator cuff and surrounding tissues.
- Ultrasonography: Excellent for depicting rotator cuff and long head of biceps pathology, and can be used to guide injections and aspirations.
According to the most recent and highest quality study, MRI, MRA, and ultrasonography are equivalent in evaluating rotator cuff injuries, depending on local expertise 1. However, MRI is currently the procedure of choice for evaluating occult fractures and shoulder soft tissues 1. It's essential to seek professional evaluation promptly if a rotator cuff injury is suspected, as early treatment can prevent further damage and improve outcomes.
Additional Considerations
- CT arthrography may be useful in evaluating the rotator cuff in patients with previous shoulder arthroplasty or those with contraindications to MRI or MRA 1.
- Ultrasound can be used to evaluate the acromioclavicular joint, tendons of the rotator cuff, and long head of biceps tendon, and is operator-dependent 1.
From the Research
Diagnostic Tests for Rotator Cuff Injury
- The evaluation of a suspected rotator cuff tear should start with a history and a clinical exam of the shoulder 2
- Three clinical test results in particular--supraspinatus weakness, weakness of external rotation, and impingement--or 2 positive tests for a patient older than 60 years were highly predictive of rotator cuff tear 2
- Either magnetic resonance imaging (MRI) or ultrasound can confirm a possible full-thickness tear 2
- Ultrasound is a valuable diagnostic tool in assessing shoulder disorders and can be as effective as magnetic resonance imaging 3
Imaging Modalities
- MRI and ultrasound (US) are accurate for identifying rotator cuff tears, but each has advantages and shortcomings 4
- Conventional arthrography is an alternative if a patient has an implantable device prohibiting MRI imaging 2
- Direct CT and MR arthrography as well as imaging evaluation of the postoperative rotator cuff are also considered 4
Predictive Factors for Treatment Response
- Early intervention positively influences the response to treatment 3
- Diabetes mellitus, arterial hypertension, and dyslipidaemia are statistically significantly associated with some rotator cuff lesions and distention of the subscapular bursa 3
- Age is the main predictor of rotator cuff ultrasound findings 3
- Shorter duration of symptoms and minor-grade MRI findings are associated with complete resolution of symptoms after fluoroscopically guided subacromial bursography and steroid injection 5