In diagnosing the source of shoulder pain, a physician will review the patient’s medical history and perform a physical examination. The physician will palpate (feel) the shoulder to try to detect physical signs of injury, and will look for limits of movement and the extent of joint instability or stiffness. The patient may be asked to complete a pain assessment.

In some cases, further testing will be necessary to pinpoint the cause of shoulder pain. Such tests may include:

• X-ray. Images may reveal more detail about the problem causing the pain. For example, the severity of a shoulder separation sometimes can be detected by taking an x-ray of the shoulder while the patient holds a light weight. This pulls on the muscle and makes the separation even more pronounced. However, traditional x-ray procedures cannot reveal all injuries.
  
  
• Arthrography. This x-ray procedure uses a contrast medium injected into the joint to outline the structures of the shoulder, such as the rotator cuff. The contrast fluid can indicate tears, openings or blockages.
  
  
• MRI (magnetic resonance imaging). This imaging technique provides cross-sectional images of the shoulder. It can be used to detect rotator cuff injuries and degenerative conditions of the shoulder, neck or spine. MRI or other imaging tests can sometimes avoid the need for arthroscopic examination.

• CAT scan (computed axial tomography). This test using multiple x-rays can detect many disorders of the joints, bones, muscles and internal organs.
  
  
• Bone scan or other radionuclide imaging. Nuclear medicine can be used to detect conditions such as bone diseases, hidden fractures and cancer.
  
  
• Blood tests. These may be ordered if infection or certain other conditions are suspected.
  
  
• Arthroscopy. A camera is inserted in the joint and visualized outside.  This procedure is usually done under general anesthesia and is performed when other diagnostic measures fail to make a diagnosis.