What Is a Rotator Cuff Tear?
A rotator cuff tear is a rip in the group of four muscles and tendons that stabilize your shoulder joint and let you lift and rotate your arms (your rotator cuff). It’s also called a complete tear or a full-thickness tear.
It’s a common injury, especially in sports like baseball or tennis, or in jobs like painting or cleaning windows. It usually happens over time from normal wear and tear, or if you repeat the same arm motion over and over. But it also can happen suddenly if you fall on your arm or lift something heavy.
Types of rotator cuff tears
There are two types of rotator cuff tears. The type you have depends on how serious your injury is. They include:
Partial tear. A partial or incomplete tear occurs when the muscles that form the rotator cuff are frayed or damaged. Although it also damages your tendon, the tissue connecting your muscle to your bone, your tendon remains attached to your arm bone. You may still be able to use your shoulder and arm with this kind of tear.
Complete tear. This type is also called full-thickness tear. It happens when the injury to your rotator cuff muscle causes your tendon to completely detach from your bone. With this kind of tear, you may feel serious pain and weakness that prevents you from being able to use your shoulder and arm.
Rotator Cuff Tear Symptoms
You can’t always feel a torn rotator cuff. But in some cases, you might:
- Have trouble raising your arm
- Feel pain when you move your arm in certain ways or lie on it
- Have weakness in your shoulder
- Be unable to lift things like you normally do
- Hear clicking or popping when you move your arm
See your doctor if you have any of these signs. If you don’t do anything about a torn rotator cuff, you can have more serious problems over time. You can end up with a frozen shoulder or arthritis that is harder to treat.
Causes of Rotator Cuff Tear
You can tear your rotator cuff in two ways: an acute tear or a degenerative tear.
Acute tear. Injuries to the shoulder, such as falling on your arm, can cause you to have an acute rotator cuff tear.
Degenerative tear. This tear occurs when you wear down your tendons over time. Your risk of having a worn-down rotator cuff goes up with:
- Occupation. Jobs like house painters and construction workers put you at a higher chance of rotator cuff tears.
- Lack of blood supply. As you get older, you get less blood to your rotator cuff area, which makes small tears hard to repair, leading to larger tears.
- Bone spurs. Bone overgrowth in the shoulder, which happens more often as you get older, can wear away the rotator cuff tissues and cause tears.
- Age. Rotator cuff tears are most common in people over 60.
- Family history. Doctors think there could be a genetic piece to rotator cuff tears. They happen more often in certain families.
- Athletics. Baseball, tennis, rowing, and weightlifting are sports that stress your rotator cuff and put you at risk of tears.
Rotator cuff injury and sports
Rotator cuff tears often happen to athletes and people who play tennis, football, basketball, volleyball and other contact sports or overhead sports (involving moving your arms and shoulders over your head). They can also occur in people who engage in weight lifting or sports that involve a lot of throwing. For instance, studies suggest that it is the third most common shoulder injury in football players.
Rotator cuff injuries can happen during sports from falls, collisions, direct blows, or overuse and strain on the shoulder. They often cause pain and can limit your ability to keep playing. As a result, many athletes with this injury can’t play as much or as well as they used to after a rotator cuff injury.
Rotator Cuff Tear Diagnosis
To find out if you have a torn rotator cuff, your doctor will start with a history of the injury and a physical examination of the shoulder. During the exam, they’ll check your range of motion and muscle strength. They’ll also see which movements make your shoulder hurt.
Rotator cuff tear test
There are many special tests doctors use to diagnose rotator cuff tear. Although they are not always reliable, you likely have a rotator cuff tear if you feel pain when doing any of these tests.
The Jobe or empty can test. Your doctor might ask you to raise your arm to shoulder level and point your thumb down so it looks like your hand is holding an empty or imaginary can upside down. Then, your doctor will push down on your arm while you resist the pushing.
The full can test. This test is just like the empty can test, except that your thumb is up, so it looks like you’re holding a full can.
The resisted external rotation. To do this test, keep your arm to your side and bend your forearm at a 90-degree angle with your palms facing up. Then, your doctor will ask you to rotate your shoulder by moving your forearm out to the side while they push against it.
Belly press test. You place your hand on your belly, and your doctor pushes your elbow forward off your stomach while you resist. If you can’t keep your hand on your stomach, it could mean that you’ve torn your shoulder muscles.
Gerber’s lift-off test. Your doctor will ask you to rotate your shoulder inward and reach behind your back with the back of your hand against your spine. Then, your doctor will tell you to try to move your hand away from your back while they prevent you from doing so. If you feel pain or weakness, it could mean you have a tear in your shoulder muscles.
MRI for rotator cuff
MRI uses radio waves and a powerful magnet to make detailed pictures of your shoulder. Your doctor will be able to look for specific abnormalities in your shoulder muscles and determine how serious your rotator cuff tear is, the type you have, and how long you’ve had them from the results of the MRI.
X-rays for rotator cuff
Your doctor will use X-rays to see if the top of your arm bone (humeral head) is pushing into your rotator cuff space. Your doctor will also check if you have other bone problems in your shoulder, like arthritis, fractures, or dislocations.
Ultrasound for rotator cuff
Ultrasound uses sound waves to make pictures of your shoulders. Your doctor can use it to see the soft tissues (tendons, muscles, and the bursas) in your shoulder. Your doctor may do an ultrasound if your shoulder X-ray shows no bone problems like fractures. It can also help your doctor quickly diagnose rotator cuff tears because they can see how your shoulders move in real time with the test. However, doctors don’t use this method as often as MRIs.
Rotator Cuff Tear Complications
If you don’t treat your rotator cuff tear, your shoulder could weaken, or you could lose the ability to move your shoulder permanently. Your shoulder joint may deteriorate too.
You’ll need to rest your shoulder as you recover, but if you keep it still for too long your connective tissue can thicken up and get tight. This is called frozen shoulder.
Rotator Cuff Tear Treatment
Your doctor is likely to start with a combination of several treatments, including:
- Physical therapy to make your shoulder muscles stronger
- Medications like acetaminophen and anti-inflammatory drugs to help with pain and swelling
- Exercises to do at home and suggestions that help you use your shoulder in safer, more comfortable ways in your day-to-day life
- Rest to allow your rotator cuff to heal
- Steroid injections into your shoulder joint, which can provide temporary pain relief
Rotator cuff physical therapy
Your doctor will recommend physical therapy as part of your treatment to help strengthen your muscles and allow them to move as well as they used to. Your physical therapy program will include stretching and strengthening exercises.
Stretching exercises help improve muscle flexibility and allow you to move your muscles fully. Strengthening exercises can help build muscle strength, reduce pain, and prevent further injuries to the affected muscles.
Rotator cuff tear exercises
Your physical therapist may create a 4- to 6-week exercise program as part of your treatment and recovery plan. Your program may be longer, depending on your case.
Your exercise program will include stretching and strengthening exercises that target different upper body muscles, including the ones on your shoulder, upper back, and upper arm. You will need to do a 5- to 10-minute warm-up by doing light exercises like walking. Then, you’ll start with the stretching exercises before you move to the strengthening exercises.
These exercises, which help improve your muscle flexibility and range of motion, include:
Pendulum
To do the pendulum exercise:
- Bend your upper body slightly. Place one hand on a table for support and let your other arm hang down.
- Gently swing your arm back and forth, side to side, and then make circular motions.
- Repeat these movements with your other arm.
Do two sets of this stretch 5 to 6 days a week.
Crossover arm stretch
To do the crossover arm stretch:
- Relax your shoulders and gently bring one arm across your chest as far as you comfortably can.
- Use your other hand to hold the stretch for 30 seconds, then release your arm for another 30 seconds.
- Repeat this stretch with the other arm.
Do four sets of this stretch 5 to 6 days a week.
Passive internal rotation
To do the passive internal rotation:
- Hold a wooden ruler or any other lightweight stick behind your back with one hand, and with your other hand, grasp the opposite end of the ruler.
- Gently pull the ruler sideways to stretch your shoulder until you feel a gentle pull without any pain.
- Stay in this position for 30 seconds and relax for another 30 seconds.
- Repeat on the other side.
Do four sets of this exercise 5 to 6 days a week.
Passive external rotation
To do the passive external rotation:
- Hold a wooden ruler or any other lightweight stick with one hand and grasp the other end with your other hand.
- As you stretch, keep your shoulder’s elbow close to your body. Push the ruler sideways until you feel a gentle pull without any pain.
- Stay in this position for 30 seconds and relax for 30 seconds.
- Do this stretch with your other side.
Do four sets of this exercise 5 to 6 days a week.
Strengthening exercises
These exercises can help keep your muscles strong and working well, reduce pain, prevent future injuries, and improve your muscle flexibility and range of motion. They include:
Elbow flexion
You need dumbbells for this exercise. Start with a weight that you can use for three sets of eight reps. Then, work your way up to three sets of 12 reps. When it starts feeling easier, exchange the dumbbells for ones about a pound heavier until you reach 10 to 15 pounds. Whenever you add more weight, go back to doing three sets of eight reps and then work your way back up again.
To do the elbow flexion:
- Stand up straight with your weight evenly balanced on both feet and hold your dumbbells.
- Keep your elbow by your side and slowly lift the weight toward your shoulder.
- Hold for 2 seconds.
- Return to the first step.
Do three sets of eight reps 3 days a week.
Rotator cuff surgery
Your doctor may recommend surgery if other treatments don’t work or if you have a complete tear. It’s likely your doctor will need to stitch together the torn area or reattach the tendon to the bone.
In some cases, they might need to take out small pieces of tendon or bone that are stuck in your shoulder joint, or remove small areas of bone or tissue to give your tendon more room to move.
Types of rotator cuff surgery:
- Arthroscopic. Your doctor will make a small cut in your shoulder then use an arthroscope -- a tube with a small camera and tiny instruments -- to fix the tear. This means your recovery time will likely be shorter than it would with another type of surgery.
- Open. Your doctor uses larger instruments to go into the muscles of your shoulder and fix the tear.
- Mini-open. This uses both arthroscopic and open methods. Your doctor starts with the arthroscope and finishes with larger instruments.
- Tendon transfer. If your tendon is too torn to reattach, the doctors can use another nearby tendon.
- Shoulder replacement. If the rotator cuff tear is large enough, you may need to have your shoulder joint replaced.
Rotator Cuff Tear Outlook
After surgery, you’ll wear a sling for 4-6 weeks. Your doctor probably will tell you to do the following to speed along your recovery:
- Take the sling off several times a day and move your elbow, wrist, and hand to get better blood flow in those areas.
- If you have pain and swelling in your shoulder, use an ice pack for about 20 minutes at a time.
- Most important: Don’t lift your arm at the shoulder until your doctor says it’s OK.
How your recovery goes will depend a lot on the size of the tear and how long your rotator cuff was torn. The smaller and more recent the tear, the better your chances of being pain-free and having a full range of motion.
Be patient. Recovery is a gradual process. It can take up to a year for you to have full use of your shoulder again.
Rotator Cuff Tear Prevention
To reduce your risk of a rotator cuff tear, especially if you’re in a high-risk category, you can do exercises to strengthen your shoulders.
You should focus on both the front muscles of the chest, shoulder, and upper arm, as well as the back of your shoulder. This balances your muscles. Ask your doctor for exercise ideas to help strengthen your shoulder area.
Takeaways
A rotator cuff tear is an injury to the muscles and tendons that stabilizes the shoulder joint. It causes pain and weakness and affects how much you can move your shoulder or use your arm. If you have any of these symptoms, see a doctor as soon as you can. Leaving a rotator cuff tear untreated can cause permanent damage, which might mean you won’t be able to move your shoulder again. Diagnosis involves a physical exam and imaging tests. Treatment may include physical therapy, medication, surgery, and rest.
Rotator Cuff Tear FAQs
Does a rotator cuff tear heal on its own?
No, a rotator cuff tear is unlikely to heal on its own without treatment like physical therapy or surgery. See a doctor if you feel any shoulder pain or weakness. They can recommend the right treatment for you.
How can I tell if I tore my rotator cuff?
If you feel pain or weakness in your shoulder, especially when you move your arm or rest on it, you might have a torn rotator cuff. If you can’t raise your arm well, lift objects like you used to, or hear popping sounds when you move your arm, it could mean your rotator cuff is torn, too.
How long does it take for a torn rotator cuff to heal without surgery?
It can take up to a year for a torn rotator cuff to heal without surgery.
How does a rotator cuff tear feel?
A rotator cuff tear could feel like shoulder pain and weakness, being unable to move your arm or lift an object with it as well as you used to, or hearing popping sounds when you move your arm.
