Investigations

• radiography: (1)
  • calcification where the cuff inserts on the greater tuberosity is commonly seen in chronic tendinitis
  • erosion of the acromium process and a high riding humeral head may be seen in a long standing tear
  • osteoarthritis of the acromioclavicular joint - common finding in older patients
    
    
• ultrasonography (1)
• MRI - effective for visualising inflammation and tears (2)
• arthroscopy - permits diagnosis and treatment

Note

If available, magnetic resonance arthrography has been found to be more sensitive and specific than MRI and ultrasound (which are equivalent) in the diagnosis of rotator cuff tears.​(2)

Reference

1. Expert Panel on Musculoskeletal Imaging; Small KM, Adler RS, Shah SH, et al. ACR appropriateness criteria: shoulder pain - atraumatic. J Am Coll Radiol. 2018 Nov;15(11s):S388-402.
2. de Jesus JO, Parker L, Frangos AJ, et al. Accuracy of MRI, MR arthrography, and ultrasound in the diagnosis of rotator cuff tears: a meta-analysis. AJR Am J Roentgenol. 2009 Jun;192(6):1701-7.