The symptoms of a rotator cuff tear are similar to those of a rotator cuff impingement sign, with the added complaint of shoulder weakness. The symptoms of weakness vary from rotator cuff tendon tear to rotator cuff tendon tear. For example, supraspinatus tendon tears (the most common type) present with weakness during anterior and supraspinatus movements of the arm. Many patients do not realize how much strength they have lost at the time of a rotator cuff tear. After a careful history and physical examination, the tear is easily diagnosed for an orthopedic surgeon experienced in the shoulder joint. Further necessary tests can clarify the nature of the rotator cuff tear. After evaluating the symptoms, the doctor will perform certain muscle tests to clarify if there is a rotator cuff tendon tear and to rule out other conditions. The doctor may hold the arm in a specific position to replicate the symptoms described to clarify the diagnosis. There are a number of tests that can differentiate between specific areas of pain and weakness to clarify the diagnosis. Further tests to evaluate include: Diagnostic injections to close the rotator cuff can help the physician differentiate rotator cuff impingement syndrome from a full rotator cuff tear. A local anesthetic is injected into the inflamed subacromial bursa to eliminate pain. If strength does not return after a pain block, a rotator cuff tear is highly suspected. X-rays can reflect signs of arthritis, fractures, and bone spurs on the acromion. Because X-rays show only bony structures and not soft tissues, there are often no positive findings in the early stages of rotator cuff injury MRI (magnetic resonance imaging) can reveal muscles and other soft tissues that are not visible on X-rays Shoulder arthrography is another method to help diagnose rotator cuff tears. If there is a tear in the rotator cuff tendon, the contrast will pass through the rotator cuff tear and show up on the X-ray. Ultrasound can also be used to diagnose rotator cuff tears, but the results are difficult to assess and are very dependent on the skill of the operator and the physician making the diagnosis.