Signs, Symptoms and Diagnosis Initially, pain occurs only when the athlete participates in any sport that requires him to hold his arm over his head and forcibly bring it forward. Later, pain may occur when the arm is moved forward to shake hands. Usually, pain will be elicited by pushing things away, with little or no pain on pulling objects in. To palpate the rotator cuff, abduct the arm backward and away from the body in internal rotation with the elbow straight. The patient will complain of tenderness over the tendons, especially when the arm is raised above the shoulder, but often not when the arm is held down by the side.
Severe pain is caused by adduction of the arm across the chest.
Shoulder abduction will be weak, usually due to underuse atrophy of the deltoid. An arthrogram is usually not sensitive enough to diagnose a partial tear of the rotator cuff but not demonstrate a complete tear. Treatment First, the injured tendons should be rested and the uninjured shoulder muscles strengthened. Surgery may be necessary if the injury is particularly severe, if there is a complete tear of the rotator cuff, or if the tendons do not heal within 1yr.