To first, diagnose whether or not your rotator cuff has been torn, a targeted examination takes place. This exam works to determine what part of the shoulder is hurt.  Often when a diagnosis becomes clear the exam will be stopped in order not to aggravate the shoulder, and typically proceed with diagnostic ultrasound.

In some cases, one or more of the following imaging tests may be recommended:

Ultrasound

Diagnostic ultrasound uses sound waves to produce images.  It is particularly good at seeing details within soft tissues such as the rotator cuff.  Often, this is the only study necessary in order to get an informed diagnosis. During an exam, the joint can be moved to see how the structures within the joint moves.  This is an advantage over MRI.

X-rays

This is usually only needed in the setting of trauma or suspected arthritis.

Magnetic Resonance Imaging (MRI)

An expensive test but sometimes required during certain diagnoses such as a labral tear.

 

Rotator Cuff Treatment Options without Surgery

 

Injections

We may recommend a steroid injection into your shoulder joint.  These can temporarily reduce pain. However, at the same time, they may shut down all healing and make the tendons weaker.  We reserve these treatments for true rescues – such as times when the person cannot sleep for multiple days in a row or is elderly and has little chance of healing a shoulder problem.  We consider steroid injections generally harmful and to be used only in desperation to relieve pain.

Growing evidence shows that Platelet-Rich Plasma Therapy (PRP) and Bone Marrow Concentrate injections help tendons heal and improve their connection to the bone.  A powerful article in the Feb. 2019 issue in Medicine Science Sports & Exercise shows that PRP therapy heals certain partial rotator cuff tears that ordinarily never heal.

Therapy

We recommend physical therapy. A mainstay of rotator cuff treatment in any scenario, physical therapy restores natural movements and encourages healing through movement. This type of intentional activation of muscle-tendon groups works well to move the healing process along.