The last blog dealt with understanding what the rotator cuff is and basically an overview about rotator cuff.
How do I know if I have rotator cuff problems?
Contrary to popular belief, history and physical examination is still an incredibly accurate way to diagnose whether you have a rotator cuff problem. An MRI is not always necessary. If you have rotator cuff disease, you will have pain during or after an activity. It will usually be located on the side of your shoulder and occasionally radiates down towards your elbow, but not below it. Sometimes it will go up towards your neck, but that is usually if it is more severe. If you have pain which wakens you from a sound sleep, it is much more likely you have a complete full-thickness tear. Weakness with reaching and overhead work is also a sign of a partial or complete tear.
Initial treatment of rotator cuff problems, in the acute setting can be use of ice 2-3 times a day and be really careful about your posture, keeping your shoulder blades back and down, and Aleve or Advil on routine schedule for several days, 5-7 days. These are things that you can do to help at home, but if the pain does not get better, and you need to finally go to the doctor, some of the preliminary treatments have already been done.
Now that you have figured your rotator cuff problem, what is the next step?
As I mentioned, history and physical examination are still the gold standard and are amazingly accurate if done thoroughly for diagnosing rotator cuff pathology. I will next do an office ultrasound to examine the rotator cuff, which is convenient, accurate and less expensive than an MRI. You also do not have to go into a closed tube!
I personally believe that MRI should be done if:
1. I cannot figure out what is going on in my history and physical.
2. If I am considering surgery on a patient, then it will help you in the decision making process.
3. If there has been 6 weeks of treatment and the pain continues
4. The ultrasound suggests a tear.
There are lots of variations in the quality of MRI scans as well as those reading them. Closed MRIs are far superior to open MRIs in terms of quality and accuracy. If you are claustrophobic, then Valium can also be given before the test to sedate you. If that is not useful, then we will obtain an open MRI or a test called CT arthrogram could be done. If it is positive, then the next step will be to discuss surgical options.
- Lesley J. Anderson, MD