Most people have shoulder pain at some point in their lives, whether due to repetitive activity, overextension, or another injury. However, if the pain does not go away, it might cause considerable problems in daily living. The first stage in treatment is to determine the source of the problem. Shoulder pain can come from a variety of factors. The rotator cuff, which can rupture or suffer from tendonitis, is one probable source of pain. Understanding these two illnesses will help your doctor and physiotherapist have a fruitful talk about your treatment options.
Shoulder tendinitis is the wrong terminology. Tendons are the part of muscle connecting to bone and tendinitis is the inflammation of tendons. The shoulder joint is one of the complex joints of the human body which constitutes many tendons.
The rotator cuff is constituted by four muscles that merge to form a common tendon. Rotator cuff tears can be degenerative or traumatic.
The common presentation in shoulder pathologies are pain, weakness, and reduced range of movements. Establishing a structural diagnosis helps treat the injury or inflammation. This can be done by careful history-taking and clinical examination. The mentioned tests by authors are provocative and can be helped in coming to conclusions. The provocative tests elicit pain so it’s not highly recommended as it can also test the overlying structures. An imaging study like MRI or ultrasonography can reveal the structures involved and the extent of injury(all imaging studies have to be correlated with clinical examination).
Rotator cuff tears and shoulder tendonitis can present with similar symptoms, such as shoulder pain and weakness. However, some differences can help differentiate between the two.
Rotator cuff tears often result in more severe and persistent pain, especially when lifting or rotating the arm. There may also be a noticeable weakness in the affected shoulder, and in some cases, a popping or clicking sensation. On the other hand, shoulder tendonitis typically involves more localized pain around the shoulder joint, particularly during movement or when pressure is applied to the area. The pain may also be accompanied by swelling and tenderness.
To accurately diagnose the condition, it’s important to consult with a healthcare professional, such as a physical therapist or orthopedic specialist, who can conduct a physical examination and possibly imaging tests, such as an MRI, to determine the extent of the injury.
On exam, you can’t. There are lots of studies that show that a competent orthopedic surgeon can tell a cuff tear a good percentage of the time. I can tell you that the exam is conclusive only in the presence of a fairly large tear. No one can diagnose a small or deep partial tear that functionally is a complete tear with any certainty. My routine was, in the case of a functionally intact shoulder by exam, or a low-demand patient with minimal impairment, to attempt conservative care for at least 6 weeks. If that approach failed, I would offer an MRI. MRI is the gold standard test to diagnose a cuff tear. The older you are, the more likely that you have a cuff tear. At age 60 I believe studies show at least 28% have tears. By age 80, 80% do. Certainly, only a small percentage of those people need or will benefit from surgical repair. Conservative care helps most of them.
I think I likely have a small tear in my non-dominant shoulder and I am NOT planning to get it fixed. I can do chores, exercise, etc. with minimal symptoms.
