Diagnosis

During the physical exam, your doctor will press on different parts of your shoulder and move your arm into different positions. He or she will also test the strength of the muscles around your shoulder and in your arms.

In some cases, he or she may recommend imaging tests, such as:

  • X-rays. Although a rotator cuff tear won't show up on an X-ray, this test can visualize bone spurs or other potential causes for your pain — such as arthritis.
  • Ultrasound. This type of test uses sound waves to produce images of structures within your body, particularly soft tissues such as muscles and tendons. It allows dynamic testing, assessing the structures of your shoulder as they move. It also allows a quick comparison between the affected shoulder and the healthy shoulder.
  • Magnetic resonance imaging (MRI). This technology uses radio waves and a strong magnet. The images obtained display all structures of the shoulder in great detail. The quality of the images depends greatly on the quality of the equipment used.

Treatment

Conservative treatments — such as rest, ice and physical therapy — sometimes are all that's needed to recover from a rotator cuff injury. If your injury is severe and involves a complete tear of the muscle or tendon, you might need surgery.

Injections

If conservative treatments haven't reduced your pain, your doctor might recommend a steroid injection into your shoulder joint, especially if the pain is interfering with your sleep, daily activities or exercise. While such shots are often temporarily helpful, they should be used judiciously, as they can contribute to weakening of the tendon.

Therapy

Physical therapy is usually one of the first treatments your doctor may suggest. Exercises tailored to the specific location of your rotator cuff injury can help restore flexibility and strength to your shoulder. Physical therapy is also an important part of the recovery process after rotator cuff surgery.

Surgery

Many different types of surgeries are available for rotator cuff injuries, including:

  • Arthroscopic tendon repair. In this procedure, surgeons insert a tiny camera (arthroscope) and tools through small incisions to reattach the torn tendon to the bone.
  • Open tendon repair. In some situations, an open tendon repair may be a better option. In these types of surgeries, your surgeon works through a larger incision to reattach the damaged tendon to the bone. Compared to arthroscopic procedures, open tendon repairs typically heal in the same length of time but recovery may be more uncomfortable.
  • Tendon transfer. If the torn tendon is too damaged to be reattached to the arm bone, surgeons may decide to use a nearby tendon as a replacement.
  • Shoulder replacement. Massive rotator cuff injuries may require shoulder replacement surgery. To improve the artificial joint's stability, an innovative procedure (reverse shoulder arthroplasty) installs the ball part of the artificial joint onto the shoulder blade and the socket part onto the arm bone.

Lifestyle and home remedies

A minor rotator cuff injury often heals on its own, with proper care. If you think you've injured your rotator cuff, try these steps:

  • Rest your shoulder. Stop doing what caused the pain and try to avoid painful movements. Limit heavy lifting or overhead activity until your shoulder pain subsides.
  • Apply ice and heat. Putting ice on your shoulder helps reduce inflammation and pain. Use a cold pack for 15 to 20 minutes every three or four hours. After a few days, when the pain and inflammation have improved, hot packs or a heating pad may help relax tightened and sore muscles.
  • Take pain relievers. Over-the-counter pain relievers such as ibuprofen (Advil, Motrin IB), naproxen sodium (Aleve) or acetaminophen (Tylenol, others) may be helpful.

Preparing for your appointment

You'll probably start by seeing your family doctor. If your injury is severe, you might be referred to an orthopedic surgeon. If you've been treated for a similar problem in the past, you may need to bring past records and imaging studies with you to your appointment.

What you can do

Before the appointment, you might want to write a list that answers the following questions:

  • When did you first begin experiencing shoulder pain?
  • What movements and activities worsen your shoulder pain?
  • Have you ever injured your shoulder?
  • Have you experienced any symptoms in addition to shoulder pain?
  • Does the pain travel down your arm below your elbow?
  • Is the shoulder pain associated with any neck pain?
  • Does your job or hobby aggravate your shoulder pain?

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

  • Where exactly is the pain located?
  • How severe is your pain?
  • What movements and activities aggravate or relieve your shoulder pain?
  • Do you have any weakness or numbness in your arm?