As with any medical issue, a shoulder problem is generally diagnosed using a three-part process:
Medical history – The patient tells the doctor about any injury or other condition that might be causing the pain.
Physical examination – The doctor examines the patient to feel for injury and to discover the limits of movement, location of pain, and extent of joint instability.
Tests – The doctor may order one or more of the tests listed below to make a specific diagnosis. These tests may include the following:
Standard x ray – a familiar procedure in which low-level radiation is passed through the body to produce a picture called a radiograph. An x ray is useful for diagnosing fractures or other problems of the bones. Soft tissues, such as muscles and tendons, do not show up on x rays.
Arthrogram – a diagnostic record that can be seen on an x ray after injection of a contrast fluid into the shoulder joint to outline structures such as the rotator cuff. In disease or injury, this contrast fluid may either leak into an area where it does not belong, indicating a tear or opening, or be blocked from entering an area where there normally is an opening.
Ultrasound – a noninvasive, patient-friendly procedure in which a small, hand-held scanner is placed on the skin of the shoulder. Just as ultrasound waves can be used to visualize the fetus during pregnancy, they can also be reflected off the rotator cuff and other structures to form a high-quality image of them. The accuracy of ultrasound for the rotator cuff is particularly high.
MRI (magnetic resonance imaging) – a noninvasive procedure in which a machine with a strong magnet passes a force through the body to produce a series of cross-sectional images of the shoulder.