The soft tissues (muscles, ligaments, and tendons) surrounding the shoulder joint are known as the rotator cuff. These tissues work together to keep your shoulder the most flexible joint in your body. However, that flexibility can come at a price: shoulder injuries are the most common form of joint damage sustained by human bodies.
Tears in the rotator cuff prevent you from doing what are otherwise easy activities, like lifting your arm or reaching overhead. The most common risk factors predicting the likelihood of developing a rotator cuff tear are age, some jobs, and family history.
There are a few telltale symptoms of rotator cuff tears. These symptoms can help you determine whether you are dealing with signs of a tear and would be vital for your torn rotator cuff treatment.
What Is a Rotator Cuff Tear and What Can Cause It?
A rotator cuff tear is a common yet painful injury that affects the shoulder. The rotator cuff is a group of muscles and tendons that surround the shoulder joint, keeping the head of your upper arm bone firmly within the shallow socket of the shoulder. When one or more of these tendons are torn, either partially or completely, it can lead to significant pain, weakness, and limited range of motion. You might recognize something is wrong if you experience shoulder clicking, pain when lifting your arm, or even shoulder popping in and out of place.
Job Requirements
Some careers seem to cause rotator cuff tears more than others. Constructor workers and other workers whose jobs require them to use repetitive arm-lifting movements, such as painting, heavy lifting, or prolonged vibration, like those who use jackhammers, are at a high level of risk for developing rotator cuff tears.
One study found that twenty years of work with these requirements put workers at risk for a rotator cuff tear or another shoulder injury at a rate four times greater than workers in other fields. If your occupation requires you to lift your arms for extended periods of time or to repetitively lift heavy weights, and you begin to feel shoulder pain, it makes sense to suspect that you could be dealing with a rotator cuff tear.
Advanced Age
Rotator cuff tears are very common, especially as you age. Over 30% of adults aged 60 or older experience a rotator cuff tear, with that number doubling to 62% for adults over 80.
All of your soft tissues begin to lose their flexibility over time, and the muscles and tendons that keep your shoulder in its socket are no different. The less flexible these tissues are, the more vulnerable you are to injury, even from very minor incidents. There is also the possibility of sustaining a rotator cuff tear from improper use of mobility aids like canes and walkers.
In order to prevent this kind of injury from happening to you, you can do daily strengthening exercises. These exercises should focus not only on the shoulders and chest area but also on the muscles in your back. A physical therapist can help you develop a routine that fits your lifestyle and ability best.
Recurring Pain
Pain in the shoulder is usually the first sign that something is wrong. This is especially true for rotator cuff injuries that develop over time, as is often the case with tears caused by overuse or repetitive movement. For rotator cuff tears, the pain will worsen with specific activities. You may also feel more pain when your arm is at rest. Many patients describe the pain as a deep, dull, constant ache. The pain may become sharper when you attempt to do activities that require more of the muscles that make up the rotator cuff, such as lifting an item or raising your arms overhead. You will have difficulty doing some everyday activities like brushing your hair.
Limited Range of Motion
Because the rotator cuff is so integral to the function of the shoulder joint, damage to the rotator cuff makes it difficult for you to move your shoulder in the ways you are used to. After experiencing an injury that caused trauma to the shoulder, you may notice that you are not able to move your shoulder as well or as flexibly as you usually do. Rotator cuff tears will especially contribute to difficulty lifting your arm overhead. You may not be able to raise it far at all.
Popping Sound
Patients with a rotator cuff tear often report a frequent popping or cracking sound when they move their shoulders. This sound is known as crepitus and can be an annoying symptom. This sound is caused by the misalignment of the ball and socket of your shoulder, causing cartilage and other tissues to rub against each other when normally the rotator cuff would allow a smoother movement.
Muscle Weakness
Since rotator cuff tears affect the muscle, weakness in those muscles is a frequent side effect. You may find that your pain is manageable but that you have difficulty lifting even small, light items. Raising your arms overhead may feel impossible, and even just moving your arm a few inches from your body can be difficult.
Difficulty Sleeping
The constant pain of a rotator cuff tear could be enough to disturb your sleep pattern, but these difficulties may increase if your injury is in the shoulder that you usually sleep on. This problem is exacerbated by the tendency of rotator cuff injuries to worsen in pain when at rest. The pain people experience at night from rotator cuff tears is due partly to gravity. Lying down causes gravity to pull at the tendons in a way that can be better avoided during the day. Pain from the night before may also make your shoulder feel stiff in the morning when you awake.
How Is a Rotator Cuff Tear Treated?
Fortunately, treatment for rotator cuff tears is usually successful. Usually, all that is required are rest, icing, and physical therapy, and most people have a complete recovery. Of course, this depends on the severity of the injury. Some people may need more intensive medical attention. Some of the shoulder pain treatments your doctor may suggest include:
Non-Invasive Treatment Options for Rotator Cuff Tears
Most rotator cuff tears, especially partial tears, respond well to non-surgical treatments. These approaches aim to reduce pain, restore mobility, and strengthen the surrounding muscles without the risks associated with surgery.
Rest and Activity Modification
The first step after a rotator cuff tear is to reduce your activity. This means avoiding activities that provoke shoulder pain, such as lifting heavy objects, reaching overhead, or performing repetitive shoulder motions. Giving your shoulder time to heal can prevent the injury from getting worse. During this period, your doctor may recommend the use of a sling to immobilize the shoulder temporarily, although prolonged immobilization is usually avoided to prevent stiffness.
Ice and Over-the-Counter Medications
Applying ice packs several times a day can help reduce inflammation and alleviate pain. Along with icing, many patients benefit from pain management with over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or aspirin. These medications decrease inflammation, relieve discomfort, and make it easier to perform rehabilitative exercises.
Chiropractic Care
Chiropractic care can be a valuable part of non-invasive treatment with its drug-free approach. Chiropractors specializing in musculoskeletal conditions can help address shoulder ligament tear injuries by using gentle adjustments and soft tissue therapies to improve joint alignment, reduce inflammation, and promote natural healing. If you’re experiencing shoulder constantly popping, chiropractic care may help improve joint mechanics and reduce abnormal movement.
Physical Therapy
Physical therapy is a cornerstone of rotator cuff rehabilitation. A physical therapist designs a personalized program that focuses on:
- Restoring shoulder flexibility and range of motion
- Strengthening the rotator cuff and surrounding muscles
- Improving posture and shoulder mechanics to prevent future injury
Physical therapists often use a combination of stretching, strengthening exercises, manual therapy, and additional modalities like ultrasound or electrical stimulation. Physical therapy can be incredibly effective, especially when started early after the injury. If you notice improvements over time and your shoulder clicking and popping diminish, it’s a good sign that healing is underway. However, persistent symptoms may signal the need for more advanced intervention.
Steroid Injections
In some cases, your doctor may recommend a steroid injection directly into the shoulder joint. These injections deliver powerful anti-inflammatory medication to reduce pain and swelling, providing relief that can make physical therapy more tolerable and effective. While beneficial, steroid injections are typically used sparingly because repeated injections can weaken the tendons over time, potentially worsening the injury.
When Surgery May Be Necessary
While many rotator cuff tears heal with conservative treatments, surgery may be required for:
- Large or complete tears
- Tears that don’t improve with non-invasive treatment after 6 to 12 months
- Significant loss of shoulder strength
- Persistent shoulder popping in and out even after therapy
- Severe pain that interferes with daily activities or sleep
Knowing the signs of a bad rotator cuff, such as an inability to lift your arm, constant weakness, or chronic shoulder instability, is critical. These symptoms suggest the damage may be too severe to heal without surgical intervention. At this point, it’s important to consult an orthopedic surgeon for a full evaluation.
Surgical Treatment Options
There are several surgical techniques available, depending on the size and location of the tear. Each surgical option has its own recovery timeline, with physical therapy playing a vital role after surgery to regain motion and strength.
- Arthroscopic Tendon Repair: A minimally invasive surgery where a small camera and specialized instruments are inserted through tiny incisions to repair the tear
- Open Tendon Repair: A traditional surgery where a larger incision allows direct access to the torn tendon
- Tendon Transfer: If the torn tendon is too damaged to repair, a nearby tendon may be used to restore function
- Shoulder Replacement: In rare and severe cases, especially where there is significant arthritis or multiple torn tendons, a shoulder replacement may be necessary
What to Expect During Recovery
Whether you undergo non-surgical treatment or have surgery, recovery from a rotator cuff tear takes time and patience. During your recovery, it’s important to monitor for recurring symptoms like shoulder constantly popping, persistent shoulder clicking, or weakness. These could indicate that the healing process isn’t progressing as expected, and further evaluation may be needed.
Here’s what you can generally expect:
- Non-Surgical Recovery: Most people start to see significant improvements within three to six months with consistent therapy and lifestyle adjustments.
- Surgical Recovery: Healing after surgery can take anywhere from four to six months or even longer for more complex repairs. A structured rehabilitation program is crucial to achieve the best results.
When to See an Orthopedic Doctor
If you’re experiencing signs and symptoms of a torn rotator cuff, such as ongoing shoulder pain, weakness, difficulty lifting objects, or any form of shoulder ligament tear, it’s a good idea to see an orthopedic doctor sooner rather than later.
You should seek prompt medical attention if:
- Your shoulder pain is severe or worsening
- You experience shoulder popping in and out frequently
- Your arm feels weak or unstable
- You notice a limited range of motion despite rest and therapy
- You have signs of a bad rotator cuff, like persistent pain at night or inability to use the arm
Visit AICA Orthopedics for a Rotator Cuff Tear
A rotator cuff tear can be painful and disruptive, but the good news is that treatment is often successful. Whether you recover with conservative measures like chiropractic care, physical therapy, rest, and NSAIDs or require surgical repair, you can regain strength and mobility with proper care. Recognizing the signs and symptoms of a torn rotator cuff early, taking action with appropriate treatment, and following through with rehabilitation are your keys to getting back to your normal activities pain-free.
If you’re experiencing shoulder clicking, shoulder ligament tear symptoms, shoulder constantly popping, or other concerning signs, don’t wait. Visit AICA Orthopedics in College Park to get the help you need to start healing today! Early diagnosis and treatment can prevent a small tear from becoming a larger, more complicated injury.