Shoulder pain is one of the most common complaints in physical therapy. 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. Most rotator cuff tears are diagnosed in people between 60-80 years old. In younger patients, rotator cuff tendinopathy is more common. If rotator cuff tendinopathy is not addressed, it can ultimately turn into a tear. So, let’s 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.
Let’s 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. This is because of its location in an already somewhat small space.
There can be 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.
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 and movement dysfunctions earlier on, the tendon can start to fray and turn into a partial tear. If this is still not addressed, it can turn into a complete tear. Based on the supraspinatus muscle’s location, it is most likely the first muscle to take the excessive stress. If a movement dysfunction continues over time, it is further limiting the space this muscle has.
The pain of rotator cuff tear is most often located at the shoulder. It can go all the way up to the neck, and/or down into the upper arm. With a smaller partial tear, you will generally not see loss of strength in 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 reaching above your head. Also having pain when sleeping and not being able to find a comfortable position. 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.
The good news is 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. This is especially true with partial tears because your body already has some guidance on the torn muscle fibers approximating and healing since part of the muscle is still attached.
There are some cases with complete tears that the ends have retracted far enough away from each other that your body will not be able to repair it. Sometimes these people still opt to not have surgery. It may not be causing them much pain or affecting their ability to function throughout the day. Recovery from surgery is long and to some it is just not worth it. Some people have pain and limited shoulder movement initially, but it improves enough that surgery is not warranted. I have seen many rotator cuff tears that initially were painful, but 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. Physical therapy will guide your body’s ability to heal naturally before considering surgery. 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!