Rotator Cuff Tear: Symptoms and Causes

About Rotator Cuff

The rotator cuff is a group of four important muscles and tendons, the supraspinatus, subscapularis, teres minor, and infraspinatus, that surround the shoulder joint. These muscles work together to stabilise the shoulder and allow smooth, controlled movements such as lifting, rotating, and reaching.

What is a Rotator Cuff Tear?

A rotator cuff tear is an injury to the group of muscles and tendons in your shoulder known as the rotator cuff. They also keep the ball of your upper arm bone (humerus) securely in the shoulder socket.

The shoulder joint is a ball-and-socket joint, similar to a golf ball resting on a tee. A rotator cuff tear occurs when one or more of the tendons pull away from the humerus. This tear can happen gradually from wear and tear or suddenly due to an injury.

Symptoms of a Rotator Cuff Tear

A rotator cuff tear can lead to significant pain, weakness, and difficulty moving the shoulder. Symptoms may come on suddenly due to an injury or gradually as the tendons wear out over time.

You may have a torn shoulder muscle if you experience:

• Pain when lifting or lowering your arm, especially during activities like reaching overhead or behind your back
• Weakness in the shoulder, making it hard to lift objects or perform daily tasks
• Clicking, popping, or crackling sounds (called crepitus) when you move your arm
• Shoulder pain that worsens at night, particularly when lying on the affected side
• Limited range of motion, such as trouble with internal rotation of the shoulder
• A dull ache deep in the shoulder, which may spread down the arm
• Sudden sharp pain after an injury, which may indicate a ruptured rotator cuff
• A feeling of a strained rotator cuff, especially during physical activity

What Causes Rotator Cuff Tears?

A rotator cuff tear can happen suddenly due to an injury or gradually over time due to wear and tear. Common causes of rotator cuff tears include:

• Injury or trauma:

A sudden fall, lifting something too heavy, or a jerking motion can lead to an acute tear. This type of torn shoulder muscle is often linked with other injuries like a dislocated shoulder or broken collarbone.

• Age-related degeneration:

As people get older, especially over the age of 40, the tendons naturally weaken. This makes the rotator cuff more prone to tears even with mild strain or repetitive use.

• Overuse or repetitive motion:

Frequent shoulder movements, common in jobs like painting or sports like tennis can stress the rotator cuff over time. This may result in a strained rotator cuff or complete tear.

• Bone spurs (shoulder impingement):

Bony growths on the shoulder bone (acromion) can rub against the tendons when you move your arm. This constant friction can wear down the tendons and lead to a tear.

• Reduced blood flow:

With ageing, blood supply to the rotator cuff tendons decreases. Without enough nutrients from blood, the tendons struggle to repair themselves, increasing the risk of a ruptured rotator cuff.

Types of Rotator Cuff Tears

A rotator cuff tear can range from mild to severe, depending on how much damage has occurred to the tendon. Types of torn rotator cuffs include:

• Partial tear (incomplete tear):

In this type, the tendon is damaged but still partly attached to the bone. It may feel like a strained rotator cuff, with discomfort or weakness during shoulder movements like internal rotation or lifting.

• Complete tear (full-thickness tear):

This is when the tendon fully detaches from the bone, often causing significant pain and weakness. There may be a visible hole or split in the tendon, often affecting muscles like the supraspinatus. This is sometimes referred to as a ruptured rotator cuff or torn shoulder muscle.

Diagnosis of Rotator Cuff Tear

Diagnosing a rotator cuff tear involves a detailed assessment of your symptoms, shoulder strength, and movement. Early and accurate diagnosis is important to prevent further damage to the rotator cuff muscles.

Physical Examination

Your doctor will begin with a physical examination to:

• Check for pain or tenderness in specific areas of the shoulder.
• Assess the range of motion by asking you to move your arm in various directions, including internal rotation of the shoulder.
• Test muscle strength to identify a strained rotator cuff or torn shoulder muscle.
• Compare your affected shoulder with the unaffected side to detect any weakness or imbalance.

Imaging Tests

To confirm a diagnosis and understand the extent of the injury, your doctor may recommend one or more imaging tests:

• X-ray

While X-rays don’t show a rotator cuff tear, they can help rule out bone spurs, arthritis, or other problems that might be causing pain.

• Ultrasound

Ultrasound uses sound waves to create images of your shoulder muscles and tendons. This test can:

• Detect tears or swelling in the rotator cuff.
• Compare the injured shoulder with the healthy one.
• Show how the muscles move in real time.

• MRI (Magnetic Resonance Imaging)

MRI is the most detailed scan for assessing a ruptured rotator cuff. It shows:

• The size and location of the tear.
• The condition of nearby muscles and tendons, such as the subscapularis or supraspinatus.
• Any signs of muscle atrophy or tendon retraction.

Treatment Types

Non-Surgical Treatments

Many rotator cuff tears can be managed without surgery:

• Rest and activity modification: Avoiding activities that exacerbate pain.
• Physical therapy: Exercises to improve flexibility and strengthen shoulder muscles.
• Medications: Over-the-counter pain relievers to reduce discomfort.
• Steroid injections: To decrease inflammation and pain.

Surgical Treatments

Surgery may be considered if symptoms persist:

• Arthroscopic tendon repair: Minimally invasive procedure using small incisions and a camera to reattach the tendon.
• Open tendon repair: Traditional surgery involving a larger incision to access and repair the tendon.
• Tendon transfer: If the torn tendon is irreparable, a nearby tendon may be used as a replacement.
• Shoulder replacement: In severe cases, replacing the damaged parts of the shoulder joint.

Complications of a Rotator Cuff Tear (If Left Untreated)

A rotator cuff tear may seem manageable at first, especially if the pain is mild. However, if left untreated, it can lead to serious and long-term complications. Any damage to these muscles, if ignored, can severely impact daily life. Without treatment you may have:

• Persistent Pain and Weakness

Over time, a strained rotator cuff or torn shoulder muscle can worsen. You may feel continuous pain, even while resting or sleeping, especially on the affected side. This can lead to disturbed sleep and chronic discomfort.

• Limited Shoulder Movement

Without treatment, you may lose the ability to fully move your arm, especially during overhead activities. Internal rotation of the shoulder may also become difficult or painful.

• Muscle Degeneration

A ruptured rotator cuff can cause the shoulder muscles to weaken and shrink (muscle atrophy). The tendons may retract or scar, making future rotator cuff treatment more complex and less successful.

• Progression of the Tear

A partial tear can become a complete tear, making it nearly impossible to lift or rotate your arm. This may affect your ability to perform basic tasks like dressing, cooking, or lifting objects.

• Shoulder Joint Arthritis

Over time, an untreated rotator cuff tear can lead to shoulder arthritis. This happens when the bones rub against each other due to the damaged tendon, causing joint pain and stiffness.

• Loss of Shoulder Function

In severe cases, permanent loss of function can occur. The longer the injury is left untreated, the less likely it is that even surgery can restore full strength or movement.

Risk Factors for a Rotator Cuff Tear

A rotator cuff tear can happen to anyone, but certain factors increase your chances of developing this condition. Damage to muscles or tendons can lead to a torn shoulder muscle or ruptured rotator cuff. Here are the key risk factors:

• Ageing

The risk of a rotator cuff tear increases with age. People over 40 are more likely to develop shoulder muscle injuries due to natural wear and tear over time.

• Repetitive overhead movements

Jobs or daily tasks that involve frequent overhead arm use such as carpentry, painting, or lifting put strain on the rotator cuff muscles. Over time, this may lead to a strained rotator cuff or tear.

• Playing certain sports

Sports like tennis, baseball, and weightlifting require repetitive arm motions. This can increase the risk of injuring the supraspinatus or other parts of the rotator cuff, especially during overhead throws or lifts.

• Family history

Genetics can play an important role. If someone in your family has had a rotator cuff tear, you may be more likely to experience one too.

• Poor posture

Slouching or having rounded shoulders can reduce the space in the shoulder joint, putting more pressure on the rotator cuff tendons, especially the subscapularis.

• Smoking

Smoking can reduce blood flow to the rotator cuff tendons, slowing down healing and increasing the risk of injury.

• Lack of shoulder strength

Weakness in the rotator cuff muscles or poor internal shoulder rotation control can make the joint less stable and more prone to injury.

How can I Prevent a Symptomatic Rotator Cuff Tear?

Here are some simple ways to protect your rotator cuff muscles and prevent conditions like a shoulder muscle tear or strained rotator cuff:

• Do regular shoulder-strengthening exercises – Strengthening the muscles around your shoulder, particularly the rotator cuff and upper back, helps keep your shoulder joint stable. Focus on controlled movements and avoid jerky motions.

• Improve flexibility – Regular stretching helps maintain the flexibility of the tendons and muscles around the shoulder. Stretching the chest, shoulders, and upper back can help reduce tension and prevent injuries.

• Use proper technique during activities – Whether lifting weights, playing sports, or performing repetitive overhead tasks, always use correct form. This reduces unnecessary stress on your shoulder tendons and muscles.

• Avoid overuse – Give your shoulders rest if you’re involved in repetitive arm movements at work or during exercise. Overuse is a major cause of torn shoulder muscles, especially in athletes and manual labourers.

• Practise good posture – Poor posture can lead to subscapularis pain and increased strain on the shoulder. Keeping your shoulders back and spine aligned helps prevent long-term stress on the internal rotation shoulder muscles.

• Warm up before activity – Always warm up before exercise or sports. This increases blood flow to the muscles and tendons and helps prevent a ruptured rotator cuff.

• Avoid smoking – Smoking can affect blood supply to the rotator cuff tendons, making them more prone to degeneration and slower to heal.

Questions Your Doctor May Ask

When you visit a specialist for a suspected rotator cuff tear, they will ask a few questions to better understand your symptoms, medical history, and possible causes. This helps in diagnosing the issue and deciding on the right course of action. Here are some common questions your doctor may ask:

• When did your shoulder pain start?
• What kind of activities make your shoulder pain worse?
• Have you ever had a shoulder injury before?
• Are there any other symptoms apart from pain like, weakness, stiffness, or limited movement?
• Does the pain extend down your arm, past the elbow?
• Do you feel any numbness, tingling, or weakness in your arm or hand?
• Is there any pain in your neck or upper back that might be related?
• Where exactly do you feel the pain – in the front, back, or top of the shoulder?
• How severe is the pain, and does it disturb your sleep?
• Are there any movements that relieve or increase the discomfort?
• Does your job or hobby involve repetitive shoulder movements or overhead work?
• Have you noticed any clicking or popping when moving your arm?
• Are you able to lift or rotate your arm fully, or does it feel limited?