1. First, Confirm It's Indeed a Rotator Cuff Tear
Other problems and conditions can mask themselves as shoulder pain. Herniated disks in the cervical spine can pinch a nerve, specifically the C5 nerve root. This nerve gives you sensation over the shoulder area. When the nerve is irritated you may feel referred pain to the shoulder, when in fact, the problem is in your neck. Other shoulder problems can manifest as weakness with overhead activity. Occasionally, a cyst can put pressure on the suprascapular nerve that runs over your shoulder blade. This can cause atrophy in the rotator cuff muscles and cause weakness. Furthermore, weakness in the shoulder blade muscles can cause difficulty with lifting your arm.
2. Diagnosis Is Made With Physical Examination and Imaging
Your doctor will move your arm through several ranges of motion to check to make sure you don't have adhesive capsulitis (frozen shoulder). The doctor also will check your strength. If there is weakness compared to the other side, or if there is pain while you are being checked, most likely you will be asked to obtain imaging studies. Plain X-rays may be taken, but they can be unremarkable, because X-rays do not visualize the tendon. An MRI or ultrasound can check the integrity of the tendon fibers and see if there is a tear. An MRI also may give the doctor information about how much the muscles have atrophied. An MRI will usually show some wear and tear of the tendon fibers (tendinosis or partial tearing). I have yet to see a completely 100 percent normal rotator cuff on MRI, even on someone as young as 11 years old.
3. Physical Therapy May Improve Your Symptoms
If there is a partial rotator cuff tear, you might want to try physical therapy. Weakness in the shoulder blade muscles can throw off the mechanics of your shoulder, irritating your rotator cuff tendons. This is manifested as a protracted, elevated shoulder blade; basically, someone who slouches or has stooped shoulders. Rebuilding the shoulder blade muscles, and retracting and depressing the shoulder blade creates more space for the rotator cuff tendons as the arm elevates.
4. You May Want to Consider an Injection
Often, subacromial bursitis is associated with rotator cuff problems. A steroid injection can calm down the inflammation in that area. But remember, too much steroid around a tendon can weaken it and cause it to tear more.
5. You May Want to Consider Surgical Repair
If nothing else is working, start thinking about having rotator cuff surgery to repair the tendon.
