This article published in the New England Journal of Medicine a few years back provides a useful perspective on the evaluation and management of the patient with suspected disease of the rotator cuff.
The diagnosis of rotator-cuff failure is suggested by a history of acute traumatic or progressive, insidious loss of shoulder strength. The physical examination of a shoulder with a rotator-cuff lesion should assess stiffness, pain on resisted motion, weakness, palpable tendon defects, crepitance, atrophy, and instability.
Plain radiographs may help rule out other diagnoses that may underlie shoulder pain (e.g., degenerative arthritis of the glenohumeral joint) and may help determine the degree to which the humeral head is aligned with the glenoid.
Ultrasonography or MRI is useful for evaluating the integrity of rotator-cuff tendons in patients when this information is needed to help guide treatment, but these imaging examinations may reveal tendon abnormalities even when the shoulder is asymptomatic.
When an acute injury results in an abrupt loss of shoulder function, the evaluation of the rotator cuff should be expedited so that a traumatic rotator-cuff tear, if present, can be repaired before muscle and tendon atrophy occur.
Here we present some of the key figures and tables from this paper.
