Rotator cuff tear Diagnostic modalities, dependent on circumstances, include X-ray, MRI, MR arthrography, double-contrast arthrography, and ultrasound. Although MR arthrography is currently considered the gold standard, ultrasound may be most cost-effective. Usually, a tear will be undetected by X-ray, although bone spurs, which can impinge upon the rotator cuff tendons, may be visible. Such spurs suggest chronic severe rotator cuff disease. Double-contrast arthrography involves injecting contrast dye into the shoulder joint to detect leakage out of the injured rotator cuff and its value is influenced by the experience of the operator. The most common diagnostic tool is magnetic resonance imaging (MRI), which can
Rotator cuff tear single physical examination test distinguishes reliably between bursitis, partial-thickness, and full-thickness tears. On the contrary, a combination of tests seems to provide the most accurate diagnosis. For impingement, these tests include the Hawkins-Kennedy impingement sign in which the examiner medially rotates the patient's flexed arm, forcing the supraspinatus tendon against the coracoacromial ligament and so producing pain if the test is positive a positive painful arc sign, and weakness in external rotation with the arm at the side. For the diagnosis of full-thickness rotator cuff tear, the best combination appears to include once more the painful arc and weakness in