Where does the pain occur?

The pain is mainly felt in the shoulder joint and can usually be precisely localized by those affected. It is particularly noticeable when the affected muscle is under stress. Lifting the arm forward or to the side can cause pain. If, for example, the supraspinatus muscle is affected, pain is mainly felt when the arm is lifted sideways. The pain can also radiate into the arm when it is moved.

Causes

Rotator cuff syndrome is usually caused by overloading or incorrect loading of the shoulder joint. This often affects athletes, but also people who work overhead can develop rotator cuff syndrome. Overloading or incorrect loading can lead to inflammation in the shoulder joint and remodelling processes. In addition, people over 50 years of age are often affected by the complaints in the shoulder, since degenerative processes can also trigger a rotator cuff syndrome.

Diagnosis

After a short questioning (anamnesis), the examination of the shoulder in particular provides indications of a rotator cuff syndrome. The doctor checks, for example, which movement triggers the pain (lifting, inward or outward rotation of the arm). If, for example, there is impingement syndrome – i.e. shoulder tightness due to an inflamed bursa – pain is felt when the arm is lifted sideways.

Various special physical tests can provide the doctor with information about the affected tendon or structure. For imaging diagnostics, X-rays can be used to assess bones and calcifications, or ultrasound and MRI to visualize soft tissue and inflammation. An MRI is only used if conservative (non-surgical) therapeutic measures do not result in an improvement or if inflammation recurs repeatedly.

Since an MRI is a very expensive examination, it should only be performed if there is a corresponding indication. In addition, an MRI is performed in the case of a rotator cuff rupture. Acute pain and an acute loss of strength indicate a rupture. The MRI is used to localize the rupture and estimate its extent.