Rotator Cuff Pain and Treatment – When do MRIs help?
Rotator cuff pain is one of the most common sources of shoulder pain in both physiotherapy and orthopaedic clinics.
You may have been told by a doctor or physio (or you may suspect from some google research!) that you have a rotator cuff tear. These can be either degenerative in nature, where there is no history of trauma, or they can occur as a result of trauma – such as a fall.
Physiotherapists treat rotator cuff pain every day, and one of the most common questions we are asked by patients with shoulder pain is ‘Do I need an MRI?’.
Traumatic rotator cuff tears that result from a sports injury or a fall often resolve with conservative management (ie initial relative rest and physiotherapy and exercises to strengthen the area) however sometimes, in a small number of cases where there is a complete or almost complete rupture with persistent pain +/- loss of function, an orthopaedic surgeon may suggest a surgical repair.
An MRI is useful in this instance as it guides the surgical decision.
It is well recognized and documented that ‘Degenerative Rotator Cuff tears’ are now considered a normal aspect of aging, and rotator cuff tears can be seen on MRI in many normal and healthy individuals who have no pain! For this reason, MRIs are not considered useful in the treatment planning and management of such tears.
In the case of these degenerative rotator cuff tension tears - ie where no trauma has occurred, there is a possibility that the patient’s shoulder pain may be unrelated to the rotator cuff tear that was noted on their ultrasound or MRI. (Note that X-ray imaging does not show rotator cuff tears).
In addition, some other findings on MRI scans (eg AC joint arthritis) are simply normal findings in many people without shoulder symptoms. As shown below, a sample of males without shoulder symptoms from ages 40-70 demonstrated how often these findings. Below that, you will see how the rate of rotator cuff tears increases naturally with age.
Males 40-70: 96% had SOMETHING present on a scan.
AJR Am J Roentgenol. 2011 Oct
Orthop Traumatol Surg Res. 2013 Dec (looked at 154 males)
If you have been experiencing shoulder pain which is not improving after 3 weeks, consider seeking some guidance and treatment from a Chartered Physiotherapist to help with pain relief and to fast track your return to normal activities and function.
A physiotherapist can advise you as to whether you would benefit from an MRI, and will liase with your GP/refer to an orthopaedic surgeon to make the process as easy as possible for you.
Garett leads the shoulder rehabilitation service at Physiofusion, and he can be contacted at 01 6077014, or you can book online to see him at: https://online.tm2app.com/physiofusion