The diagnosis of shoulder problems begins with a medical history and physical examination. Important considerations in your history are:
- how long you've had the problem
- whether your shoulder simply started to hurt or if you suffered an injury to the shoulder
- where you feel the pain
- whether you have any other medical problems
Once a clear history is obtained your doctor will examine the shoulder. The physical examination will focus on:
- trying to determine where the pain is located
- assessing the strength of the shoulder muscles
- finding any restrictions in shoulder motion
- looking for signs of shoulder instability
- using various physical tests for specific shoulder problems
X-rays
X-rays of the shoulder may be ordered on the first visit. X-rays show the bones of the shoulder. They may also give us clues about the condition of the tendons and soft tissues. For example, sometimes X-rays of the shoulder will show wear-and-tear arthritis in the joint. X-rays can help confirm your doctor's initial diagnosis from the history and examination.
Arthrogram
To get a better idea what is happening with the ligaments and tendons around the shoulder, special tests are usually needed. The arthrogram is a special test where dye is injected into the shoulder joint. X-rays are then taken of the shoulder. If the dye leaks out of the shoulder joint and into the bursa, a tear in the rotator cuff tendons is likely.
MRI Scan
The MRI scan is used frequently to look at the tendons and ligaments of the shoulder. The MRI scan is a special test that uses magnetic waves to take slices of the shoulder in several directions. Unlike X-rays, the soft tissue structures can be seen on the MRI scan.
Laboratory Tests
Not all pain in the shoulder is caused by mechanical problems in the shoulder. Other problems, such as arthritis, pinched nerves in the neck, and even gallstones can cause your shoulder to hurt. Other special tests and laboratory tests may be necessary to look into your shoulder problem, if your doctor thinks the problem may not be in the shoulder itself.
