Rotator Cuff Tear

What is a rotator cuff tear?

The rotator cuff is a group of four muscles that attach the bone to the shoulder blade, allowing you to lift and twist your arm. A rotator cuff injury tear can cause a dull ache in the shoulder, which often worsens when sleeping.

The rotator cuff is a common site of shoulder injuries, and a tear is one of the most common injuries—along with strains, tendinitis, and bursitis. Tears can happen gradually when the tendons that connect muscles to bones overstretch and then tear in part or entirely.

There are many reasons that this can happen, including repetitive stress from repeating the same motion, a lack of blood supply, and bone overgrowth from age. The rotator cuff can also tear after a fall, a car accident, or from a sudden injury.

The pain from sudden tears is usually instant and more intense than from gradual tears.

Rotator cuff pain is caused by a tearing of the supraspinatus muscle, which lies on top of the shoulder. Its tendon moves under the bone on the outside of the shoulder (the acromion). This tendon is one of the most frequently torn because of its location between the bones.

When the tendon tears, it becomes sore and swollen and can then get stuck between the shoulder bones. It can also damage the sac of fluid that cushions the tendon.

A rotator cuff tear can weaken the shoulder and make daily activities very painful.

Symptoms

Typically, the pain is located in the front or on the outside of the shoulder. It is usually worse when you raise your arm or lift something above your head. The pain can be very severe and make it hard to do even simple tasks. Rotator cuff tears are usually very painful at night because lying down stretches many of the muscles in this area and the mattress can press against the area.

Signs of a rotator cuff tear include:

• Pain that doesn’t improve with rest
• Shoulder pain at night
• Shoulder pain when lifting the arm
• Crackling sensation when the shoulder moves

Rotator cuff tendinitis and frozen shoulder are two distinct shoulder conditions that can sometimes be confused due to their similar symptoms. Rotator cuff tendinitis involves inflammation of the tendons that connect the rotator cuff muscles to the shoulder bone, while frozen shoulder, also known as adhesive capsulitis, is characterized by stiffness and restricted movement of the shoulder joint.

While both conditions can cause shoulder pain and limited range of motion, there are key differences. Rotator cuff tendinitis typically results in pain when lifting or lowering the arm, especially overhead. Frozen shoulder, on the other hand, causes a more severe limitation in shoulder movement in all directions, often described as a "stuck" feeling.

It's important to note that rotator cuff tendinitis can sometimes lead to frozen shoulder if left untreated. This is because the pain from tendinitis may cause a person to limit shoulder movement, potentially leading to the development of adhesions in the shoulder capsule. Treatment approaches for these conditions differ, with rotator cuff tendinitis often responding well to rest, physical therapy, and anti-inflammatory medications, while frozen shoulder may require more intensive interventions such as corticosteroid injections or, in severe cases, manipulation under anesthesia.

Understanding the differences between these conditions is crucial for proper diagnosis and treatment, as addressing the underlying cause can help prevent further complications and promote faster recovery.

Treatment

Your doctor may do a rotator cuff injury test or a drop arm test.

A rotator cuff tear needs to be treated or it will get worse. While treatments for rotator cuff tears vary depending on the severity of the tear, it usually includes rest, over-the-counter pain medication, strengthening exercises, and stretching. Steroid injections can help with pain and physical therapy with recovery. If symptoms last more than six months, surgery may be recommended.