The starting point for treating any rotator cuff problems is a thorough rotator cuff injury assessment. There are a few basic stages in this assessment process and is it this that I want to cover in detail.

Pretty much anyone with any rotator cuff problems will undergo this process. If you have had problems In the past this should be familiar territory.

No matter how your injured rotator cuff occurred an initial doctor’s assessment will be required. A family doctor is most people’s first port of call.

Only if you have been unlucky enough to have suffered a major trauma or serious shoulder damage will you start out at a hospital. I will assume that you are starting with the family doctor.

This is roughly what you should experience. I have tried to set it out in a structured way. Your experience may be slightly different but don’t be concerned by that.

Initial Consultation

Every initial diagnosis starts with a thorough consultation. The consultation will be split into two distinct phases. The first is an explanation of events that led up the muscles of the rotator cuff becoming injured.

A fact finding phase, if you like. The second phase should be a thorough physical examination.

History of the injury

The fact finding phase should also cover two distinct areas. Initially your recent relevant medical history should be discussed.

Especially any earlier rotator cuff disease or anything that you may have suffered that previously affected the shoulder. It will also include the seeking of a detailed account of exactly what triggered the rotator cuff problems you are now experiencing.

Second should be a review of how the condition affects you physically. Again this will include two basic sections detailing the onset of the rotator cuff problems and how the injured rotator cuff feels now.

You will be asked to cover such things as

1. When did the pain start
2. What did it feel like
3. Where was the pain
4. Was it gradual or sudden onset
5. Any loss of function

The second phase will be more about how the injury feels now, such things as

1. What is the pain like i.e. dull or sharp
2. How has it changed
3. Where is the pain located
4. What weakness do you have
5. What range of movement do you have

Physical examination

As an example of what you may experience I intend to focus upon the tests used to establish a rotator cuff tear.

It is important to remember that for a torn rotator cuff, weakness either with or without pain is the key diagnostic sign.

It is this weakness that a number of these tests are seeking to establish.

Firstly however the doctor will conduct a visual examination.

This will be followed by pressing and feeling around the affected area.

The doctor will be looking for any of the following signs

1. Swelling
2. Discolouration
3. Muscle wastage
4. Deformities
5. Tenderness
6. Warmth

Your range of motion will tested; along with stability and strength. Your reflexes, blood flow and the sensation in the affected area will be measured. This will then be compared to the uninjured joint.

This comparison is so important to establish as accurately as possible the extent of the rotator cuff problems.

The tests below are generally used to establish the site and scale of a rotator cuff tear. It may be necessary to follow up with more detailed tests such as xray and mri scans.  Nevertheless, they should provide a fairly accurate initial assessment.

• -Hold your arm straight out to your side with your thumb down. Lower your arm slowly. If it drops suddenly, you probably have a rotator cuff tear.

• -Hold your arm straight out to the side, level with your shoulder, with your palm facing down (make a fist). Your doctor will press your arm down to determine your strength in this position.

• -Raise your arm straight out in front of you, about shoulder height, and turn your wrist so your thumb points toward the floor. Your doctor will try to push your arm down against your resistance. If your rotator cuff is weak or torn, you will not be able to hold your arm steady.

• -Raise your arm straight out in front to about shoulder height. Now turn your palm up toward the ceiling. Doctor will try to force your hand downward against your resistance. If your rotator cuff is weak or torn, you will not be able to hold your arm steady. If you have more pain or weakness in this position, you may also have bicep tendon damage.

• -Hold your arm at your side, bend your elbow, and turn your wrist so your thumb points toward the ceiling. Your doctor will try to force your hand in toward your stomach as you resist by trying to rotate your arm outward (shown above). If your rotator cuff is weak or torn, you will not be able to hold your arm steady

• -Raise your arms alongside your ears, with your palms facing inward. Your doctor will stand behind you and push your arms forward. If you have trouble resisting this, you may have a rotator cuff tear.

There are, as I said earlier, other tests for other rotator cuff problems such as bursitis or impingement. This is just to give a flavour of how in depth rotator cuff injury assessment can and should be.