Torn Rotator Cuff: Key Signs, Symptoms & Healing Options

Torn Rotator Cuff: Signs, Symptoms and How to Heal

A torn rotator cuff is a common shoulder injury that affects more than 2 million people in the U.S. each year, according to the American Academy of Orthopaedic Surgeons. While rotator cuff tears can’t heal on their own, nonsurgical treatments can help boost your shoulder’s function and lower pain.

Key Takeaways

A torn rotator cuff may cause pain while performing daily activities or exercising, but some people may not experience any symptoms after tearing their rotator cuff.
Doctors can diagnose a torn rotator cuff by doing a physical examination, ultrasound, x-ray or MRI. These exams will help them determine the severity of the tear.
Pain from a torn rotator cuff may be helped by physical therapy. However, some peoples’ torn rotator cuffs may need surgery.

The term rotator cuff refers to the muscles and tendons that connect to keep your arm in its shoulder socket and to help lift and rotate the arm.
A torn rotator cuff occurs when there’s a tear in these tendons.

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Signs and Symptoms

It’s possible to have a torn rotator cuff without experiencing any symptoms, says Dr. Alejandro Badia, a hand surgeon and upper extremity
orthopedic surgeon at Badia Hand to Shoulder in Doral, Florida. In fact, 50% of tears don’t cause symptoms, If you do experience symptoms, they may include:

Pain in the shoulder area. The pain may travel down to the outside of your arm and continue to the elbow.

“The pain usually intensifies with quick movements of the arm or reaching behind the back or overhead to dress, shower or comb hair,” says Samantha Marner, a physical therapist at Advanced Physical Therapy in Wichita, Kansas.

Pain when sleeping on the affected shoulder. You might not feel pain in the day, but pain that wakes you up in the night or pain upon waking up can be a sign of a rotator cuff tear.
Shoulder weakness. You might notice this when performing tasks that involve lifting an object in the front of your body, such as grabbing a gallon of milk from the fridge, Marner says.

Types of Rotator Cuff Tears

Types of rotator cuff tears include:

Partial tear. With a partial tear, the tear is only partly through the tendon.
Full-thickness tear. With a full-thickness tear, part of the tendon is detached from the bone.
There are full-thickness incomplete tears, where only some of the tendon is detached from the bone.
There are also full-thickness complete tears, which are characterized by a complete detachment of the tendon from the bone.

Causes and Risk Factors

The main causes of a torn rotator cuff include:

Aging as tissues in the body wear down over time
An injury, such as a fall or collision during a high-contact sport, like hockey or football
Repetitive activities that involve the rotator cuff, like tennis, baseball and swimming

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Risk factors associated with a torn rotator cuff include:

Being over the age of 60
Doing repetitive activities like carpentry, house painting or throwing that involve the rotator cuff
History of trauma in the shoulder area
Lowered blood flow to the rotator cuff

Diagnosis

To diagnose a torn rotator cuff, a health care provider may perform:

A physical exam of your shoulder. This may allow the provider to get a better sense of where the pain you’re feeling is and how severe it might be.
An MRI scan. This is the most common way to diagnose a rotator cuff tear and what type of tear it is. MRI results can provide information about the tear that can help the provider make certain decisions related to surgery.
An X-ray. This can help rule out other potential causes for shoulder symptoms, such as shoulder
arthritis or bone spurs.
Ultrasound. Doctors may use ultrasound imaging to check for tears in the tendons.

Treatment

Treatment for a rotator cuff tear may or may not involve surgery, and the treatment chosen is based on the amount of pain and the type and extent of the tear.

Physical therapy often plays a major role in helping someone regain strength and motion from a rotator cuff injury, although it won’t heal a tear.
“The goal of physical therapy in treating a torn rotator cuff with or without surgery is to restore functional shoulder mobility and strength to eliminate pain and return to usual activities,” Marner says.

Physical therapy is commonly used after rotator cuff surgery for as long as three to six months.
When searching for a physical therapist, look for someone who’s experienced in treating shoulder injuries and rotator cuff tears.
Your surgeon can likely recommend a particular physical therapist for your
recovery from surgery that also works with your insurance.

Other treatments to help pain or inflammation from a torn rotator cuff include:

A cortisone injection. This can lower inflammation and pain, but it won’t cure the rotator cuff.
If used too often, it could worsen the tear.

Platelet rich plasma injections. This is a type of therapy made from a patient’s blood
that is then injected into an injured area. The treatment is rich in plasma and can help
heal an injury more quickly.
Bone marrow aspirate injections, which use an injection of a patient’s bone marrow
(the spongy tissue deep in the bones) to lower inflammation and help provide normal function
to joints and tendons.
Nonsteroidal anti-inflammatory drugs. These NSAID drugs, like Advil and Aleve,
can help reduce pain associated with the injury, but will not help heal the tear.
An arm sling. In some cases, a doctor may recommend use of an arm sling to immobilize
the shoulder and allow the arm to heal.

Options like platelet rich plasma injections and bone marrow aspirate injections may help patients
looking for more natural treatment options, but they won’t cause reattachment of a fully torn,
retracted rotator cuff tendon.

“I always take the time to discuss what the potential consequences of leaving a tendon torn could be,”
says Dr. Brian Lee, an orthopedic surgeon at Cedars-Sinai Kerlan-Jobe Institute in Los Angeles
and an orthopedic consultant for the PGA Tour. “With time, large tears can become irreparable due
to tear enlargement, scarring and muscle atrophy.”

Surgery, typically performed as an outpatient procedure at an
ambulatory surgery center or hospital outpatient department,
is another option for a rotator cuff tear if someone isn’t responding to conservative, nonsurgical
treatments. A surgeon will perform rotator cuff surgery arthroscopically, which means making small
incisions and using a small tube with a camera called an arthroscope to reach the site of the tear.
Surgeons then use special instruments to repair the rotator cuff.

When choosing an orthopedic surgeon for a rotator cuff repair, look for a shoulder specialist as they
will have more familiarity with treatment options tailored to you. “If a tear is not repairable, a
specialist can typically make the decision during surgery to perform an alternate reconstructive
procedure,” Lee says.

Recovery time for surgery may depend on a person’s activity level, age and size of the tear,
Lee says. Generally speaking, you should be able to return to normal activities six to eight weeks
after surgery and when you begin rehabilitation exercises. You’ll need to wear a sling for the first
few weeks of your recovery.

While there are other causes of shoulder pain, torn rotator cuffs are a common shoulder injury that can
greatly affect your arm’s range of motion and your overall quality of life, especially if it becomes
painful. That’s why it’s important to see your doctor about any shoulder pain you may be experiencing
before it gets worse.

Sources

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Alejandro Badia, MD, FACS
Dr. Alejandro Badia is a hand and upper extremity orthopedic surgeon treating hand, wrist, arm, forearm,
elbow and shoulder problems at Badia Hand to Shoulder Center in Doral, Florida.
Dr. Badia founded OrthoNOW®, the first immediate orthopedic urgent care center in South Florida.

Brian Lee, MD
Lee is medical director of the Emergency Care Center at Providence St. Joseph Hospital in Orange, California.

Samantha Marner, PT, DPT
Marner is a physical therapist at Advanced Physical Therapy in Wichita, Kansas.