Rotator Cuff Tear: Common Signs and Treatment Options
Key takeaways:
Rotator cuff tears are common injuries to the muscles and tendons that hold the shoulder joint in place. They can happen because of sudden trauma or long-term overuse of the shoulder.
Common symptoms of a rotator cuff tear include pain when you use your arm and difficulty raising your arm overhead. But this depends on the severity of the tear and whether it happened suddenly or over time.
Rotator cuff tears can improve on their own by avoiding activity that causes pain. Other treatment includes physical therapy, over-the-counter pain medications, and joint injections. In some cases, the injury needs surgical repair.
The rotator cuff is a group of muscles and tendons surrounding the shoulder. The shoulder is a ball-and-socket joint. It lets the arm move in many more directions than a typical hinge joint like the elbow. This requires a complex system to keep the joint stable and strong while allowing for flexibility and movement. This is the rotator cuff’s job: It allows you to rotate your arm toward and away from your body, out to the side, and overhead.
The complex structure of the rotator cuff comes at a price — it’s prone to injury. We’ll go over what causes a rotator cuff tear, what it feels like when you have one, and the typical treatment.
What is a rotator cuff tear?
The rotator cuff consists of four muscles. These four muscles wrap around the shoulder blade and then come together to form a strong tendon. This tendon connects to the upper arm bone (the humerus).
A rotator cuff tear can involve any one or more of those muscles or their associated tendon. There are a few types of rotator cuff tears:
Partial tear: This is an injury to one of the muscles or tendons that don’t go all the way through it. It’s like a frayed rope that is still attached, but it’s thinner than it should be.
Full-thickness incomplete tears: This is when the tear goes all the way through one of the tendons or muscles. But other parts of the rotator cuff are still attached.
Full-thickness complete tears: This is when the muscle or tendon is completely torn off and is no longer attached at all.
What causes a rotator cuff tear?
A rotator cuff tear can happen in many different ways. It can happen with sudden trauma to the arm — like a fall. But these injuries usually happen with wear and tear over time. This is particularly true when there’s repeated stress on the shoulder joint from activities like tennis, weight lifting, or jobs that involve physical labor.
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What are the symptoms of a rotator cuff tear?
The most common symptoms of a rotator cuff tear are:
Pain: When there’s pain, it often occurs in the top part of the shoulder, particularly with reaching overhead, lowering the arm, or reaching behind the body. People may also experience pain when they lie down on the affected shoulder.
Weakness: This can happen with more serious tears. This may be particularly noticeable when trying to reach overhead. Someone may also have trouble rotating their arm toward and away from the body.
Crepitus: This is a cracking, popping, or clicking sensation in the joint with movement.
It’s important to note that not all rotator cuff tears are painful. Some people notice weakness more than pain. This is more likely with tears that develop slowly over time with repetitive use.
Who is at risk for rotator cuff injuries?
Rotator cuff tears are more likely when the muscles are weak. And there are a number of circumstances that can make muscles weaker than normal:
Increasing age: As people age, the rotator cuff weakens for two reasons — natural wear over time and decreased blood flow to the shoulder. People over 40 years old are at increased risk of injury.
Repetitive overhead tasks: People with careers and hobbies that involve a lot of overhead lifting are at increased risk of rotator cuff tears. Some examples are painters, carpenters, construction workers, and nurses.
Athletes: Just like jobs and chores, sports that involve heavy use of the shoulder can weaken the rotator cuff. Tennis, baseball, and rowing are common examples.
How do you diagnose a rotator cuff tear?
Diagnosing a rotator cuff injury usually starts with a physical exam. Your provider will feel the shoulder joint to see which parts are painful to the touch. They’ll also check for any pain and weakness with certain movements of the shoulder. This can provide many clues that suggest a tear.
The next step in diagnosis is usually imaging studies. These include:
X-ray: An X-ray can only show bone, so it can’t provide a picture of the rotator cuff. But many people still get an X-ray first to rule out other causes of shoulder pain, like arthritis or fractures.
Ultrasound: This test uses painless sound waves to look at structures beneath the skin. Many people are familiar with its use in pregnancy, but it can also find muscle or tendon injuries. It can even tell how serious they are.
MRI (magnetic resonance imaging): This study gives a detailed, 3D picture of the shoulder, including the muscles and tendons of the rotator cuff. An MRI is the most definitive way to diagnose a rotator cuff tear and see how serious it is.
How do you treat a rotator cuff tear?
The initial treatment for a rotator cuff is usually rest and rehabilitation. This involves reducing pain and inflammation, letting the injury heal, and strengthening the joint.
Some common treatments are:
Movement restrictions: This one might seem obvious, but it can be hard for many people to let their body rest— especially their shoulder and arm. Avoiding movements that cause pain can help prevent further injury and provide time to heal.
Pain medication: Over-the-counter pain relievers can help reduce pain from a rotator cuff tear. Ibuprofen (Advil, Motrin) or naproxen (Aleve) are common recommendations that can help.
Physical therapy: Targeted exercises can help strengthen the rotator cuff to help it heal and prevent further injury.
Steroid injections: A provider can inject strong anti-inflammatory medications like steroids into the shoulder joint. This helps reduce pain and inflammation.
When is surgery needed for a rotator cuff tear?
In some cases, a rotator cuff tear needs surgery. This depends on someone’s degree of injury and response to other treatments. Some situations in which surgery may be a treatment option are:
Prolonged symptoms lasting more than 6 to 12 months despite other treatments
Large tears that are unlikely to heal on their own
Severe pain or joint weakness that leads to a loss of joint function
Sudden, traumatic injuries
This decision should also take into account other medical conditions that make surgery riskier. For example, if someone has a serious lung or heart condition, this can increase the chance of complications from general anesthesia. You and your surgeon will also consider any conditions that increase your risk of infection or poor wound healing — like a weakened immune system, diabetes, or peripheral vascular disease.
The bottom line
Rotator cuff tears are a common injury. They usually occur over time and can lead to weakness or pain with certain arm movements. But the good news is that, in many cases, these injuries don’t need surgery. They often improve with rest, medications, and other noninvasive treatments.
If you’re having shoulder pain, talk with your provider, a sports medicine specialist, or an orthopedic surgeon. They can help you figure out the cause of your shoulder pain and decide on which treatments are best for you.
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References
Maruvada, S., et al. (2022). Anatomy, rotator cuff. StatPearls.
May, T., et al. (2022). Rotator cuff injury. StatPearls.
MedlinePlus. (2022). Rotator cuff injuries.
OrthoInfo. (2022). Rotator cuff tears.
