eMedicine Specialties > Sports Medicine > Shoulder

Rotator Cuff Injury: Differential Diagnoses & Workup

Author: Gerard A Malanga, MD, Founder and Director, New Jersey Sports Medicine Institute; Director of Pain Management, Overlook Hospital; Director of Sports Medicine, Sports Medicine Fellowship Director, Mountainside Hospital; Clinical Chief, Rehabilitation Medicine and Electrodiagnosis, St Michael's Medical Center; Medical Director, Consultant, Horizon Healthcare Worker's Compensation Services, Blue Cross and Blue Shield Worker's Compensation
Coauthor(s): Christopher J Visco, MD, Staff Physician, Department of Rehabilitation, Kessler Institute for Rehabilitation, University of Medicine and Dentistry of New Jersey; Stephen G Andrus, MD, Sports Medicine Fellow, Department of Physical Medicine and Rehabilitation, Kessler Institute for Rehabilitation, University of Medicine and Dentistry of New Jersey; Jay E Bowen, DO, Assistant Professor, Clinical Coordinator Sports Medicine Fellowship, Department of Physical Medicine and Rehabilitation, Kessler Rehabilitation Corporation
Contributor Information and Disclosures

Updated: Jan 29, 2009

Differential Diagnoses

Acromioclavicular Joint Injury
Angina Pectoris
Bicipital Tendonitis
Cervical Radiculopathy
Myocardial Infarction

Other Problems to Be Considered

Adhesive capsulitis
Glenohumeral arthritis
Shoulder subluxation/dislocation

Workup

Imaging Studies

  • Plain radiography of the shoulder can be very helpful in the diagnosis of rotator cuff disease. Standard views should include a true anteroposterior (AP) view (in the plane of the scapula), a supraspinatus outlet view, and an axillary view.
    • The true AP view helps determine acromiohumeral distance, which is narrowed in association with rotator cuff tears. This view also identifies sclerosis and spurring of the acromion and reactive changes at the rotator cuff insertion site on the greater tuberosity, including sclerosis and cyst formation, all of which are associated with chronic tears.
    • The outlet view (a lateral radiograph in the scapular plane with the beam tilted 10° caudad) helps identify acromion shape and slope.
    • The axillary view helps identify the humeral head position in relation to the glenoid.
  • Magnetic resonance imaging (MRI) has replaced arthrography as the criterion standard for diagnosing injuries to the rotator cuff.
    • MRI is a noninvasive imaging modality that is extremely sensitive and specific. It can be used to detect the size, location, and characteristics of rotator cuff pathology.
    • In a rotator cuff tear, the tendon demonstrates a bright signal on T1-weighted images that increases significantly on T2-weighted images.
    • The increased signal on T2-weighted images is fluid that is filling the defect and helps to differentiate a frank tear from tendinosis.
    • MRI is a very costly technique that requires absolute lack of patient motion while the patient is being scanned.
    • A small percentage of patients are unable to complete the test secondary to pain or claustrophobia.
  • Ultrasonography may also be used to evaluate the rotator cuff.25
    • This modality is inexpensive, convenient, and highly accurate in detecting full-thickness rotator cuff tears.
    • Ultrasonography can be used to characterize the extent of the rotator cuff tear and to visualize biceps tendon dislocation.
    • One drawback to this modality is that it is extremely operator dependent, and the sensitivity and specificity of this test in detecting rotator cuff tears vary with the ultrasonographer's skill.

Other Tests

  • Electrodiagnostic testing: EMG and nerve conduction testing are helpful in the evaluation of possible suprascapular nerve impingement and involvement of the long thoracic, axillary, musculocutaneous, spinal accessory, and brachial plexus nerves and to rule out cervical radiculopathy as a cause of shoulder pain and weakness.

More on Rotator Cuff Injury

Overview: Rotator Cuff Injury
Differential Diagnoses & Workup: Rotator Cuff Injury
Treatment & Medication: Rotator Cuff Injury
Follow-up: Rotator Cuff Injury
Multimedia: Rotator Cuff Injury
References
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Further Reading

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Keywords

rotator cuff tear, rotator cuff tendonitis, rotator cuff tendinitis, supraspinatus tendonitis, subacromial tendonitis, subacromial tendinitis, impingement syndrome, shoulder injury, shoulder pain, loss of shoulder motion, supraspinatus atrophy, infraspinatus atrophy, entrapments of suprascapular nerve,

scapular winging, scapulohumeral rhythm, adhesive capsulitis, dropping of the arm, scapula rotators, drop-arm test, Neer impingement test, Hawkins-Kennedy impingement test, apprehension test, relocation test, intrinsic tendinopathy, curved acromions, hooked acromions, rotator cuff tendinopathy

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Contributor Information and Disclosures

Author

Gerard A Malanga, MD, Founder and Director, New Jersey Sports Medicine Institute; Director of Pain Management, Overlook Hospital; Director of Sports Medicine, Sports Medicine Fellowship Director, Mountainside Hospital; Clinical Chief, Rehabilitation Medicine and Electrodiagnosis, St Michael's Medical Center; Medical Director, Consultant, Horizon Healthcare Worker's Compensation Services, Blue Cross and Blue Shield Worker's Compensation
Gerard A Malanga, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, North American Spine Society, and Physiatric Association of Spine, Sports and Occupational Rehabilitation
Disclosure: Nothing to disclose.

Coauthor(s)

Christopher J Visco, MD, Staff Physician, Department of Rehabilitation, Kessler Institute for Rehabilitation, University of Medicine and Dentistry of New Jersey
Christopher J Visco, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Medical Association, and American Medical Student Association/Foundation
Disclosure: Nothing to disclose.

Stephen G Andrus, MD, Sports Medicine Fellow, Department of Physical Medicine and Rehabilitation, Kessler Institute for Rehabilitation, University of Medicine and Dentistry of New Jersey
Stephen G Andrus, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, American Medical Association, and Physiatric Association of Spine, Sports and Occupational Rehabilitation
Disclosure: Nothing to disclose.

Jay E Bowen, DO, Assistant Professor, Clinical Coordinator Sports Medicine Fellowship, Department of Physical Medicine and Rehabilitation, Kessler Rehabilitation Corporation
Jay E Bowen, DO is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American College of Sports Medicine, and American Osteopathic Association
Disclosure: Nothing to disclose.

Medical Editor

Andrew L Sherman, MD, MS, Associate Professor of Clinical Rehabilitation Medicine, Vice Chairman, Chief of Spine and Musculoskeletal Services, Program Director, SCI Fellowship and PMR Residency Programs, Department of Rehabilitation Medicine, Leonard A Miller School of Medicine, University of Miami
Andrew L Sherman, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American College of Sports Medicine, American Medical Association, American Paraplegia Society, American Spinal Injury Association, and Association of Academic Physiatrists
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Henry T Goitz, MD, Fellowship Director, Sports Medicine, Department of Orthopedic Surgery, Henry Ford Hospital
Henry T Goitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons and American Orthopaedic Society for Sports Medicine
Disclosure: Nothing to disclose.

CME Editor

Jon B Whitehurst, MD, Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner and Executive Board Member, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital
Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

Chief Editor

Craig C Young, MD, Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Sports Medicine Fellowship Director, Medical College of Wisconsin
Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, Phi Beta Kappa, and Wilderness Medical Society
Disclosure: Nothing to disclose.

 
 
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