Rotator Cuff Tear: Causes, Symptoms AND What To Do About It

by | Sep 24, 2021 | Shoulder

Shoulder pain is one of the most common complaints in physical therapy. It can be caused by many different issues, but in this article we are going to discuss rotator cuff tears in particular. This is a very common diagnosis that physical therapists see. It accounts for around 12% of all shoulder injuries in the general population with most rotator cuff tears being diagnosed in people between 60-80 years old. In younger patients, rotator cuff tendinopathy is more common, which if not addressed can ultimately turn into a tear. So, lets break down exactly what a rotator cuff tear is, what causes them, and some tips and guidance on what to do if you think you may have a torn rotator cuff.


What Is A Rotator Cuff Tear?

Lets start by going over some of the anatomy. The rotator cuff includes 4 different muscles that attach to the scapula and to the top of the humerus. This includes the Supraspinatus, Infraspinatus, Subscapularis and Teres Minor. A tendon is what attaches a muscle to bone. The tendons of all of these muscles attach to the humerus. The rotator cuff and the capsule keeps the arm bone seated in the socket when we move our arm in different directions. The most common muscle of the rotator cuff to get torn is the supraspinatus because of its location in an already somewhat small space.

A rotator cuff tear is when there is a tear in one or more of the 4 rotator cuff muscles. This can vary from a mild fraying to a partial tear to a complete tear. Rotator cuff tears usually happen gradually along this spectrum.



What Causes Rotator Cuff Tears?

A rotator cuff tear is very rarely from one singular event, it is most often a slow progression of wear down over time. A small amount may be related to genetics or a specific traumatic injury, but most of them happen gradually over time. This is why it is more commonly seen in an older population. There are usually warning signs of tendinopathy or impingement symptoms when you are younger that can progress to a tear if not taken care of. There are videos related to tendinopathy and impingement that you can find on our youtube channel. By not addressing these tendon irritations, movement dysfunctions and muscle imbalances earlier on, they can eventually wear on the tendon enough that it starts to fray and turn into a partial tear, which ultimately if not addressed can long term turn into a complete tear. This is why the supraspinatus muscle is more prone to a tear. Based on this muscle’s location, it is most likely the first muscle to take the brunt of the stress if a movement dysfunction continues over time that is further limiting the space this muscle has.



What Are The Symptoms Of Rotator Cuff Tears?

The pain of rotator cuff tear is most often located at the shoulder, but can go all the way up to the neck, and down into the upper arm. With a smaller partial tear, you will generally not see loss of strength of your arm, but it could make overhead tasks more difficult and/or painful. When there is a larger partial tear, a complete tear or multiple tears, you will notice weakness with certain movements and lifting your arm up. The most common complaint with rotator cuff tears is pain when sleeping on the shoulder or reaching above your head. There are different grades of rotator cuff tears, so some people may experience no pain, while others will have extreme pain with lifting their arms. The severity of the tear does not always correlate with the pain, but in general partial tears are more painful than complete tears, because you still have attachments there.



What Should I Do If I think I have a Rotator Cuff Tear?

The good news is even if you have a tear that does not necessarily mean you need to have surgery. Your body is very capable of repairing tears on its own, especially partial tears because it already has some guidance on the muscle fibers approximating and being able to re-attach since part of the muscle is still attached. There are some cases with complete tears that the ends of retracted far enough away from each other that your body will not be able to repair it, but sometimes people still opt to not have surgery because it is not causing them much pain or affecting their ability to function throughout the day much. Recovery from surgery is long and to some, it is just not worth it. I have seen many rotator cuff tears that initially were painful and the patient had limitations and through physical therapy, they were able to get back to what they needed to pain-free and took surgery off the table. Regardless of the severity of the tear or what you have been told is seen on an MRI, you should always take a conservative approach first with physical therapy to guide your body’s ability to heal naturally before considering surgery, especially considering the lengthy physical therapy following surgery anyway. For more information on avoiding surgery with a rotator cuff tear click here

If your shoulder is hurting, listen to your body and take action. So many shoulder injuries can be avoided when given the proper care sooner. Listen to the warning signs and find a physical therapist!


    Dr Joseph Rosi II, DPT, Cert DN, CSCS

    Dr. Rosi was born and raised in Dayton, OH. He graduated from The University of Findlay with a dual degree – a Bachelors of Science in Kinesiology as well as a Bachelors of Arts in Spanish where he was immersed in the culture and lived in Costa Rica while studying at La Universidad de Costa Rica- San Pedro.  He then returned to University of Findlay and continued to graduate school to pursue his Doctor of Physical Therapy degree. During this time he completed mission work in Nicaragua, in which he served many young families who were unable to access the most basic forms of healthcare. 

    After graduation, he set out to continue to learn and enhance his hands-on clinical skills, where he spent the next two years completing a Manual Therapy Certification from The University of Saint Augustine in St. Augustine, FL.  During this time he also completed his certification in Dry Needling from the American Academy of Manipulative Therapy. He also took coursework and furthered his specialty into male pelvic health. During this time he traveled, learned and worked in many different clinics in multiple states including Ohio, Texas, Indiana, South Carolina, New Mexico, California, and now Florida where Alinea Performance was born.

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