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What Is A Rotator Cuff, And Why Can It Be Painful?

rotator cuff pain

Do you have shoulder pain?

Could it be coming from your rotator cuff?

A group of tendons and muscles is present within your shoulder known as the "rotator cuff."

They help you lift your arms and move them away from your body. Additionally, the rotator cuff keeps the humerus (ball in the upper arm bone) where it should be - inside the shoulder socket.

Unfortunately, the rotator cuff is extremely vulnerable to injury, which can result in intense pain. But there are a million other reasons why you might have shoulder pain, so it may not be your rotator cuff. 

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What Is A Rotator Cuff Tear?

Like the hip joint, the ball and socket joint in the shoulder is an integral part of your skeletal system. 

A rotator cuff tear happens when the tendons snap away from the bone. It could be because of a traumatic injury like a vehicle accident, trip, or fall, or it can sometimes occur due to wear and tear and overuse of the shoulder joint, muscles, and ligaments.  

More than 2 million people all over the US suffer from rotator cuff issues every year.

Although they can affect people of all genders and age groups, the elderly tend to be most susceptible due to natural wear and tear in the shoulder joint. 

Various types of rotator cuff injuries can occur, including:

  • Complete: If there is a complete rotator cuff tear, the tendon rips off the bone completely, leaving a hole in the tendon.
  • Partial: In a partial rotator cuff tear, the tendon still connects to the bone to a certain extent.  

Does rotator cuff pain affect one or both shoulders?

If the tear is due to wear and tear, a rotator cuff tear is more likely to occur on your dominant side (the arm you use most often).

But there could be instances when it happens on the other – in the case of an accident, trip, slip, or fall. 

What Causes Rotator Cuff Tears?

shoulder pain

Any accident like a significant fall where the shoulder dislocates or the collarbone breaks can result in a painful rotator cuff tear.

But the most common cause of rotator cuff tears is aging as the shoulder joint, and the rotator cuff undergo “wear and tear” and degenerate.

Although most patients are much older, anyone above 40 statistically falls into the higher risk category. 

Some other causes of rotator cuff tears include: 

  • Decreased circulation: With advancing age, blood circulation to the rotator cuff decreases. For the tendons and muscles to remain healthy, you must have good circulation. In addition, decreased blood supply caused by inflammation, arthritis, and pre-existing medical conditions or vascular problems can lead to tears over time.
  • Bone spurs: Sometimes, growths known as “bone spurs” can occur on the shoulder bone. These cause friction against the tendon when you lift or rotate your arm. This friction between the tendon and the bone can lead to a complete or partial rotator cuff tear.
  • Repetitive use: Professions, sports, or other activities that involve repetitive movements can cause stress on the tendons and muscles that can cause a rotator cuff tear.

What Are The Risk Factors For Rotator Cuff Tears?

rotator cuff pain

While a rotator cuff injury can occur with anyone, certain factors raise the risk, such as: 

  • Smoking and tobacco use
  • Maintaining a poor posture
  • Being over 40 years old
  • Family history of rotator cuff issues
  • Poor circulation
  • Repetitive shoulder activities or movements like professional athletes, playing tennis, rowing, basketball, etc. Vehicle technicians, painters and decorators, joiners, and carpenters.

What Are The Symptoms Of A Rotator Cuff Tear?

shoulder pain

A sudden rupture of the rotator cuff due to an accident can lead to pronounced shoulder weakness – where you struggle to lift your arm and intense shoulder pain.

But if your rotator cuff tear is a degenerative tear caused by overuse and wear and tear, then you may only experience mild discomfort that you can relieve with over-the-counter pain medication.

However, even with these types of tears that develop over time, the pain is likely to intensify, and OTC medication cannot stop the pain anymore. 

While all cases of rotator cuff problems may not have pain as a symptom, the telltale sign and common factor with all issues relating to the rotator cuff is shoulder and arm weakness.

Although, in rare cases, there may not be any symptoms at all, and you only discover the injury on a routine x-ray or scan. 

Other symptoms of rotator cuff problem are:  

  • Finding it difficult to raise the arm above the shoulder 
  • Pain that increases at night or when lying down 
  • Difficulty in picking up items
  • A clicking/popping sound upon moving the arm

Getting A Rotator Cuff Diagnosis 

Getting A Rotator Cuff Diagnosis

If we suspect a rotator cuff tear, we examine your range of motion and the strength in your arm and look for tender spots around the shoulder joint. 

Based on this evaluation, we might recommend further diagnostic tests like:

  • An Ultrasound/MRI scan to detect any tears in the tendon 
  • An X-ray to look for bone spurs or arthritis

We always recommend a consultation with a professional physical therapist for fast and effective diagnosis and treatment of rotator cuff tears. But you can self-check for rotator cuff problems if you’re curious. 

Start by placing the sore arm behind your back with your palm turned outwards on the small of your lower back.

Then, try to move the hand and arm away from your back. If this movement is painful or you struggle to move the arm away from your back due to weakness, it could signify a rotator cuff tear or another injury.

If this is the case for you, we recommend Book A Free Consultation and physical evaluation immediately. 

Treating A Rotator Cuff Tear 

Human shoulder pain with the anatomy of a skeleton shoulder

If you ignore a rotator cuff tear and don't seek treatment, it usually worsens over time. For instance, a complete rotator cuff tear can become extremely painful when you try to move your arm.

Sometimes, making it challenging to move or use the arm at all, so we would not recommend that strategy. 

Sadly, the body’s natural healing capacity cannot fix rotator cuff tears. But surgery isn't necessary in most cases unless you have a complete rotator cuff tear. You will require treatment.

It won’t get better on its own. Non-steroid anti-inflammatory medication and steroid injections can temporarily reduce the inflammation and kill the pain for a while. 

But it always comes back. You can also try resting the arm and wearing a sling. But the most effective treatment for a minor or partial rotator cuff tear is physical therapy. 

We help you strengthen and stretch the shoulder muscles and the tendons in the rotator cuff in a controlled manner, which helps to lower inflammation and reduce your pain. 

Do I Need Surgery For My Rotator Cuff Tear?

rotator cuff pain physical therapy

You might require surgery to fix the issue if you have severe pain that doesn't respond to nonsurgical treatment and physical therapy.

It may also be the best choice for mild to moderate rotator cuff tears if you’re a professional sports player or work in a profession involving repetitively using the shoulder.

Surgeons usually perform Rotator cuff surgery via an arthroscope with a minor incision (keyhole).

While you generally have the surgery done as an outpatient with same-day discharge from the hospital (in most cases), the surgery is significant, and full recovery can take a long time. 

If your surgeon cannot manage to fix the rotator cuff due to the age or size of the tear, they may use other options like tendon transfer, debriding the scar tissue, or reverse shoulder replacement. 

During the surgery, the surgeon makes a minor incision on the shoulder, so they can insert an arthroscope to operate.

These tiny instruments that go into the shoulder via the incision reattach the torn tendons and remove any bone spurs that might be present too. 

If you have a partial tear, it may be possible only to remove the frayed pieces of the tendon, known as debridement. 

This surgical process helps to keep the ball and socket joint in the shoulder from rubbing against the tendon and causing further damage. 

Post-surgery you must keep your arm in a sling to keep it immobile and resting for a couple of weeks, so you won't be able to use the arm.

After this, you can gradually start physical therapy to restore your movement and strength over a few months.

Unfortunately, it can take four to six months and sometimes even longer to fully recover from rotator cuff surgery.

So if you can – it pays to get physical therapy sooner rather than later to prevent the need for surgery and more severe rotator cuff injury. 


Tom Willemann

Tom Willemann

Tom Willemann is a premier physical therapist based out of Bergen County, New Jersey. He holds an MS in physical therapy from the University of Miami, is credentialed in the world-renowned McKenzie Method of Mechanical Diagnosis and Therapy (MDT), and holds an OCS (Orthopedic Clinical Specialist) certification. As of 2018, there are approximately 14,000 ABPTS certified specialists in the nation and less than 400 of them are located in the state of New Jersey. Tom is the owner and director of Apex Orthopedic Rehabilitation in Paramus. He opened the clinic, which specializes in spine and sports injury prevention, in 2004 after many years of experience in the field. Tom’s caring interest in others and his strong belief in continuity of care, combined with his clinic’s ability to find solutions for the most difficult orthopedic problems, have earned Apex Orthopedic Rehabilitation its excellent reputation with patients and medical professionals in northeastern New Jersey and beyond. A true “family man,” Tom takes pride in his clinic’s warm and welcoming environment.
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