Torn Rotator Cuff: Causes, Symptoms, and Treatment

By Tim Wall, MS, ATC

Grasping the Basics of a Torn Rotator Cuff: Causes, Signs, and Treatment

A torn rotator cuff is a regular injury that impacts the shoulder joint. It takes place when the tendons in the rotator cuff, a collection of muscles and tendons that encircle the shoulder joint, get torn or damaged. This can happen due to a variety of reasons, such as repetitive overhead movements, aging, or a sudden injury.

Indications and symptoms of a torn rotator cuff may involve pain, weakness, limited motion range, and trouble sleeping on the affected shoulder. If you think you have a torn rotator cuff, it’s critical to seek medical help for an accurate diagnosis.

There are non-surgical treatment options available for a torn rotator cuff, like physical therapy, medication, and rest. In more severe cases, surgical treatment may be necessary to mend the torn tendons.

Torn Rotator Cuff

The shoulder is a ball (humeral head) and socket (glenoid/labrum) joint that allows a person to have a multidirectional arm movement.  This joint is held into place by a group of 4 muscles and tendons called the rotator cuff: Supraspinatus, Infraspinatus, Teres Minor, and Subscapularis. These muscles provide support for the shoulder and assist with abduction, external rotation, and internal rotation.  The most frequently torn rotator cuff muscle is the supraspinatus due to its position. This muscle crosses a site under the acromial-clavicular joint when bone spurs typically occur. Dr. Kamal Bahsali explains rotator cuff injures in this VIDEO.

Understanding a Torn Rotator Cuff

The rotator cuff is a collection of muscles and tendons that encircle the shoulder joint, giving stability and allowing a wide range of motion. When one or more of these muscles or tendons get torn, it’s referred to as a torn rotator cuff.

Understanding the rotator cuff anatomy:

The rotator cuff consists of four main muscles: the supraspinatus, infraspinatus, teres minor, and subscapularis. These muscles start from the scapula (shoulder blade) and attach to the humerus (upper arm bone). They work together to assist in lifting and rotating the arm.

Rotator cuff function:

The primary function of the rotator cuff is to stabilize the shoulder joint, keeping the humerus securely in the socket. It also helps with various shoulder movements, such as lifting, reaching, and throwing.

Common reasons for a torn rotator cuff:

A torn rotator cuff can happen due to various reasons, including:

• Acute injury or trauma, like a fall or lifting a heavy object
• Repetitive overhead motions, often seen in athletes or individuals involved in certain occupations
• Age-related wear and tear, as the tendons become weaker and more prone to tearing

It’s critical to seek medical help if you suspect a torn rotator cuff, as early diagnosis and treatment can help prevent further damage and improve recovery outcomes.

Symptoms of a Torn Rotator Cuff

If you’re feeling pain and weakness in your shoulder, it could be a sign of a torn rotator cuff. The rotator cuff is a collection of muscles and tendons that encircle the shoulder joint, giving stability and allowing for a wide range of motion. When these muscles or tendons get damaged or torn, it can lead to various symptoms.

One of the most common signs of a torn rotator cuff is pain. You may feel a dull ache in your shoulder that worsens with certain movements or activities. The pain can also radiate down the arm. Additionally, you may notice weakness in the affected shoulder, making it hard to perform everyday tasks like lifting objects or reaching overhead.

Another symptom to be aware of is a limited range of motion in the shoulder. If you find it challenging to move your arm fully or experience stiffness when trying to reach or lift, it could indicate a torn rotator cuff. This limitation in mobility can greatly impact your daily activities and overall quality of life.

Many individuals with a torn rotator cuff also struggle with sleep due to shoulder discomfort. When lying down, the weight of your body can put pressure on the injured shoulder, causing pain and making it challenging to find a comfortable position. This can lead to restless nights and fatigue during the day.

If you’re experiencing any of these signs and symptoms, it’s essential to consult with a healthcare professional. They can evaluate your condition, provide an accurate diagnosis, and recommend appropriate treatment options to help you recover from a torn rotator cuff.

• Pain on the outer portion of the shoulder.
• Difficulty/pain when trying to sleep on that shoulder.
• Pain with overhead movements.
• Cracking/popping sensation with arm movements.
• Weakness or inability to lift or rotate the arm.

Types of Torn Rotator Cuff

Full-thickness- This occurs when there is a complete tear of the muscle, separating the tendon from the bone.

Partial-thickness– The tendon has damage or wear and tear; however, it still connects to both the muscle and the bone.

Acute Tear– Usually caused by trauma such as a fall, a quick movement, or heavy lifting can also be caused.

Chronic Tear– AKA degenerative tear occurs over time as the tendon wears down.  Degeneration occurs as we age, but other factors can speed up the degeneration and make some people more susceptible to this type of tear than others.

Repetitive stress– Occurs with chronic overhead motions from baseball/softball, tennis, rowing, and weight lifting.

Bone spurs– These bone overgrowths typically occur on the underside of the acromion. They rub on the tendons of the RTC as we move our shoulders.  Over time this will wear down the tendon and make it more likely to tear.

Reduced Blood Supply:   If the tendons of the RTC do not receive adequate blood supply for prolonged periods of time, they are not getting the healing factors to help repair small tears that occur.

Diagnosing a Torn Rotator Cuff

When experiencing shoulder pain and limited mobility, it’s important to seek a proper diagnosis to determine if you have a torn rotator cuff. A torn rotator cuff is a common injury that can happen due to overuse, trauma, or degeneration of the shoulder joint.

Diagnosing a torn rotator cuff usually involves a combination of a physical examination by a doctor, imaging tests like an MRI or ultrasound, and diagnostic procedures for accurate diagnosis.

During a physical examination, your doctor will assess your shoulder’s range of motion, strength, and any signs of tenderness or swelling. They may also perform specific tests, such as the drop arm test or the lift-off test, to evaluate the integrity of your rotator cuff muscles.

Imaging tests like MRI or ultrasound can provide detailed images of the soft tissues in your shoulder, allowing the doctor to visualize any tears or abnormalities in the rotator cuff. These tests help in confirming the diagnosis and determining the severity of the tear.

In some cases, your doctor may recommend diagnostic procedures such as an arthrogram or a shoulder arthroscopy. An arthrogram involves injecting a contrast dye into the shoulder joint, followed by an X-ray or MRI to highlight any tears or other abnormalities. Shoulder arthroscopy is a minimally invasive surgical procedure that allows the doctor to directly visualize the inside of the shoulder joint and repair any damage to the rotator cuff.

It’s crucial to consult with a healthcare professional for an accurate diagnosis of a torn rotator cuff. They will consider your symptoms, medical history, and results from physical examination and imaging tests to determine the most appropriate treatment plan for your specific condition.

Diagnosis of a torn rotator cuff can be performed through a physical exam and imaging.  Specific tests, which will measure your strength and range of motion, will be performed by your physician to help rule out any other possibilities.  Most physicians will want to perform an MRI to confirm the tear. Also, calculate the size and significance of the possible tear to determine the treatment options.

Treatment Options for Rotator Cuff Injuries

Non-Surgical Treatment Options for a Torn Rotator Cuff

If you have experienced a torn rotator cuff, you may be wondering about the non-surgical treatment options available to you. While severe cases may require surgery, many individuals find relief and improvement through non-surgical methods. Here are some effective options to consider:

Physical therapy exercises and stretches:

Physical therapy plays a crucial role in rehabilitating a torn rotator cuff. A skilled physical therapist can guide you through exercises and stretches that help strengthen the muscles around the shoulder joint and improve flexibility. These exercises are designed to gradually restore range of motion and reduce pain.

Pain management techniques:

Managing the pain associated with a torn rotator cuff is essential for your overall well-being. Your healthcare provider may recommend over-the-counter pain relievers or prescribe stronger medications if necessary. Additionally, applying ice or heat to the affected area can provide temporary relief. It’s important to follow your healthcare provider’s guidance on pain management to ensure optimal recovery.

Use of braces or slings for support:

Braces or slings can provide support and stability to the shoulder joint during the healing process. These devices help limit excessive movement and protect the torn rotator cuff from further injury. Your healthcare provider may recommend a specific type of brace or sling based on the severity of your condition.

Remember, it’s crucial to consult with a healthcare professional to determine the most suitable non-surgical treatment options for your torn rotator cuff. They will assess your condition and provide personalized recommendations based on your specific needs. By following their guidance and being consistent with your treatment plan, you can increase your chances of a successful recovery without the need for surgery.

Most physicians will attempt to prescribe non-surgical treatment options as an initial approach to allow the body to heal itself.  This is especially true if the patient only suffers a partial tear or is not a good candidate for surgery.  If a full-thickness tear is present, this makes the conservative approach more difficult.  However, if the pain and inflammation are under control, the body can compensate for the injury to the shoulder.

Non-surgical options include:

• Rest.
• Ice.
• Anti-inflammatory medications.
• Steroid injections.
• Physical Therapy.
• Dry Needling
• Laser Therapy

Surgical/Operative Management

With surgical advancements, recovery time and the ability to regain function continues to improve over the years.  The surgeons at Jacksonville Orthopedic Institute are using the latest technology and up-to-date surgical techniques.  Therefore, this allows them to perform RTC repairs where the tendon’s attachment to the bone is stronger.  This gives a patient a better chance of regaining full function and reducing risks of re-injury.

If you would like to learn more about a Rotator Cuff Infraspinatus Tear, please go to this article: content infraspinatus tendon tear.

Physical Therapy for Rotator Cuff Tears

Following a rotator cuff repair surgery, a patient can expect to begin physical therapy (PT).  The initial phase of PT should consist of a passive range of motion performed by the therapist to minimize joint stiffening.  Once the surgeon determines that the healing process is far enough along, the patient will begin working on an active range of motion.  The next stage is strengthening and endurance exercises.  JOI’s goal is to help improve athletes’ performance to reduce the risk of injury or re-injury.

Post-operative rehabilitation is an essential component of the overall treatment plan. It focuses on gradually increasing the range of motion, strengthening the shoulder muscles, and improving functional abilities. The rehabilitation program may include exercises such as pendulum swings, shoulder stretches, and resistance training. The length of the rehabilitation period may vary depending on the individual and the extent of the tear.

If you have a rotator cuff tear’s condition or symptoms and would like to make an appointment with JOI Rehab, call 904-858-7045. 

Related Articles: rotator cuff injuries and Top 5 Worst Shoulder Exercises. 

If you have recently had a shoulder surgery, please watch this helpful video: Dressing the Upper Body After an Injury or Surgery

JOI and JOI Rehab

At JOI Online, we understand the importance of providing comprehensive information about surgical treatment for a torn rotator cuff. Our experienced orthopedic specialists utilize the latest techniques and technologies to ensure optimal outcomes for our patients. If you have any questions or would like to schedule a consultation, please contact us today.  Our goal is to help you get back to the activities that you love without shoulder pain.

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By: Tim Wall MS, ATC