Diagnosis of Rotator Cuff Pain
A key diagnostic technique for rotator cuff tears is the Look Feel Move approach to physical examination of the shoulder. Poustie (2010) describes this approach as looking for bruising, swelling, wounds, scars, or any atrophy of the supraspinatus and infraspinatus muscles, the latter of which would indicate a chronic tear of the tendons. It is also important to compare both shoulders to look for asymmetry (Boynkin, et al., 2010). Feel, according to Poustie (2010) means to palpate the hard and soft tissues in the shoulder to determine if the pain derives from joints or bones or from myofascial pain. The move portion of the examination is to do a series of strength tests to determine what movements can be performed and which cannot. These should be done first with the non-injured shoulder to provide a baseline to which the injured shoulder can be compared (Boynkin, 2010).
Rotator cuff disease is sometimes called “overuse syndrome” and occurs with overuse of the shoulder in repetitive lifting (Poustie, 2010). This causes microtrauma and can lead to partial tears and tendonitis. Typically, pain is worse at night and is particularly worse when doing overhead activities (Poustie, 2010). The differential diagnosis based on the history of the patient. If the pain is acute, it may be an injury other than a rotator cuff injury or possibly a dislocated shoulder plus a rotator cuff tear (Boynkin et al., 2010).
Treatment for rotator cuff tears can be either operative or non-operative. The conservative treatment is non-operative. Typically this may include physical therapy, using stretching or strengthening exercises, local steroidal injections, oral anti-inflammatory medications, or changing activity techniques (Boynkin et al, 2010). Generally, only if these non-operative interventions do not work is an operative intervention tried. Seida, et al. noted that a wide variety of operative techniques have been documented, but evidence is not strong enough to warrant recommending a specific technique as superior. All provided significant patient improvement with few complications and even fewer clinically significant complications (Seida, et al, 2010).