Rotator cuff Perth - The role of MRI - Dr Sven Goebel - Shoulder Surgeon

Rotator cuff Perth

The role of MRI in diagnosing and assessing rotator cuff tears

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Rotator cuff Perth

MRI is the gold standard to diagnose rotator cuff tears

Your rotator cuff is a group of muscles and tendons in your shoulder that helps you move and lift your arm. You can tear it suddenly if you fall or hurt your shoulder. Commonly however, it is a slow degenerative process which is part of ageing. 

An MRI is the most reliable way to look at your rotator cuff tendons, because it clearly shows the abnormalities in tendons, muscles, and bones.

“The MRI shows us very clearly if there is a tear in a tendon because the tear looks different from the rest of the healthy parts on the MRI, which helps us figure out what is wrong.”
Dr Sven Goebel | Shoulder surgeon Perth
Dr Sven Goebel

Ultrasound can detect tears in your rotator cuff tendons, but it is not perfect. Ultrasound scans are performed by technicians who have greatly varying skills and experience. Also, if you are overweight or cannot move your shoulder well because of pain, the ultrasound might not get a good look at your tendons. 

“When your GP suspects a rotator cuff tear, it is common to start with an ultrasound. It is a quick, non-invasive, and more cost-effective option compared to MRI. But if you ask me, as a rotator cuff specialist here in Perth, it is often hit and miss, because it depends too much on the skills of the sonographer.” 

Dr Sven Goebel | Rotator Cuff Specialist Perth 

Rotator cuff Perth

X-rays and CT scans do not show the tendons in your shoulder clearly, so they might look like they are blending in with the nearby muscles and bones. This makes it hard, sometimes even impossible, to tell if there’s a tear using these methods. 

A wrong conclusion can lead to other issues. Let’s take a look at the associated risks of a delayed diagnosis or misdiagnosis.

Dr Sven Goebel

Rotator cuff misdiagnosis

Risks of delayed or wrong diagnosis

As a shoulder surgeon here in Perth, I regard MRI as the gold standard for diagnosing rotator cuff tears. Soft tissue can be clearly seen, and this accuracy is crucial for planning the most effective shoulder treatment. Delayed diagnosis or misdiagnosis can lead to several complications:  

  • Muscle atrophy: If you wait too long to get treatment for a shoulder problem, the muscles around your shoulder can start to get weaker and smaller. This is called muscle atrophy. Especially if the tendon has completely torn off the bone, the muscle attached to that tendon can start to weaken and shrink. Over a few months, this muscle can even turn into fat, a condition known as “fatty atrophy.” Once this happens, it can’t be reversed. Even if you have surgery to attach the tendon back to the bone, the muscle might stay weak and not work properly if it has changed too much. That’s why it’s really important to get the right diagnosis quickly. Catching the problem early gives you the best chance for a good recovery.
  • Worsening condition: What might have been a small, manageable tear could become larger and more complex, possibly requiring more invasive treatment or surgery.
  • Increased pain and discomfort: Without accurate diagnosis and appropriate treatment, you’re likely to experience prolonged pain and discomfort, which can impact your daily activities and quality of life.
  • Decreased mobility: The longer a rotator cuff tear goes untreated, the more likely you are to experience decreased range of motion and strength in the affected shoulder, which can make simple tasks difficult.
  • Frozen shoulder: This is a condition characterised by stiffness and pain in the shoulder joint. A delay in treating a frozen shoulder can mean a prolonged course to recovery or chronic symptoms.
  • Complicated surgery: If the tear worsens or leads to other shoulder problems, rotator cuff surgery (if needed) becomes more complicated and may have a lower chance of full recovery.

Rotator cuff surgery Perth

Does your rotator cuff injury require surgery?

As an MRI can really show if your muscles have gotten weaker or smaller, it can help decide if fixing the tear with shoulder surgery is a good idea. On my rotator cuff webpage, I write about your non-surgical and surgical options.

“If the tear can’t be fixed, there are alternative surgeries that can help your shoulder move better and hurt less. One common surgical option is to replace the shoulder joint in a “reverse” style, especially if there’s also arthritis there.” 

Dr Sven Goebel | Shoulder Surgeon Perth 

This “reverse” surgery, or reverse shoulder replacement surgery, swaps the positions of the ball and socket in your shoulder, which can help keep your shoulder stable even if the muscles around it aren’t working well. 

Getting an accurate MRI reading is key to figuring out the best way to treat your shoulder, whether you need surgery or not.