Torn Rotator Cuff
Symptoms & Treatment

The rotator cuff muscles surround the joint holding the ball and socket together, connecting the humerus to the shoulder blade.

Each rotator cuff muscle arises from the shoulder blade and forms tendons which attach on to the humerus. It is the tendon parts of the rotator cuff that tend to get damaged. 

The four muscles that make up the rotator cuff are:

• Supraspinatus: across the top of the shoulder. Initiates abduction i.e. moving the arm out sideways, and stabilises the shoulder during movement. Supraspinatus us the most commonly damaged rotator cuff tendon
• Infraspinatus: at the back of the shoulder. Laterally rotates the arm i.e. turns it outwards
• Teres Minor: at the back of the shoulder below infraspinatus. Laterally rotates the arm i.e. turns it outwards
• Subscapularis: runs across to the front of the shoulder. Medially rotates the arm i.e. turns it inwards

Find Out More: Muscles Of The Shoulder >

Degeneration, i.e. wear and tear, is the most common cause of torn rotator cuff symptoms. As we age, the rotator cuff increasingly experiences wear and tear from: 

1. Repetitive Friction: repetitive activities which involve the rotator cuff, increases the strain on the tendons. Activities where the arm is frequently overhead such as sports with throwing motions or racket sports, occupations involving manual labour and general day-to-day activities above head-height particularly increase the strain on the rotator cuff making it prone to damage.  
   
   
2. Bone Spurs: as we age, we can develop bone spurs, small outgrowths of bone which make our joints less smooth. These spurs can rub on the tendon, leading to fraying and tearing of the tendon.
   
   
3. Poor Posture: can also make you more prone to a degenerative rotator cuff tear. One example of this is a forward rounded posture, known as kyphosis, as it reduces the space in the shoulder joint, increasing the pressure on the tendons.
   
   
4. Aging: Over the age of around forty, any damage to the rotator cuff tendons is slower to heal as the blood isn’t as good as when we are young, so often tears never get a chance to heal properly and get progressively worse. As a result, you are much more likely to experience torn rotator cuff symptoms over the age of forty.

With a degenerative torn rotator cuff symptoms tend to start of fairly mild and get progressively worse over time. Acute rotator cuff tears more typically cause instant, intense pain.

Torn rotator cuff symptoms commonly include:

• Pain: across the shoulder, often described as a dull ache deep inside.  Rotator cuff tear symptoms tend to get worse when lifting or rotating your arm, with activities such as brushing your hair, or when lying on that side in bed, which often leads to disturbed sleep.  As the condition gets worse, you may experience pain even when resting the arm
  
  
• Weakness: difficulty lifting or twisting the arm are common torn rotator cuff symptoms, which can lead to decreased range of movement
  
  
• Crepitus: you may notice funny shoulder clicking, cracking, grinding or popping noises when you move the arm due to the decreased stability of the shoulder

Torn rotator cuff symptoms will depend on the severity of the injury. 

They will then examine the arm, looking at your range of movement and strength, palpating the different structures and moving your arm into different positions. They may well also examine your neck, as neck problems often present with shoulder pain.

Depending on your torn rotator cuff symptoms, they may send you for further investigations, such as x-rays, to look for any bone spurs or arthritis or an MRI or ultrasound scan to look at the soft tissues and identify the presence, location and size of a tear.

There are three grades for tendon strains:

• Grade 1 Strain: overstretching of tendon, but no fibers are torn
• Grade 2 Strain: a partial rotator cuff tear – some of the fibers are torn
• Grade 3 Strain: a complete/full thickness rotator cuff tear - the tendon completely detaches from the bone. In this case, you may lose the ability to abduct your arm, i.e. struggle to lift it to the side

• Rest: It is important to avoid activities that cause pain, else the rotator cuff tear can get worse. With acute tears, you may be given a sling to wear initially. However, it is really important to keep the arm moving in a pain-free range, otherwise stiffness and weakness can develop
  
  
• Physical Therapy & Exercises: a physical therapist can work on a rehab program with you to help you regain strength and movement in the shoulder as well as address any underlying issues such as poor posture from long term weakness and tightness which may have contributed to the tear in the first place. They may also carry out deep transverse friction massage to help the tendons heal correctly and/or acupuncture to help relieve pain. Visit the rotator cuff exercises section to find out more
  
  
• Medication: Your doctor may recommend painkillers and/or anti-inflammatories to reduce your torn rotator cuff tear symptoms of pain and swelling
  
  
• Improve Posture: Thinking about how you sit, particularly if you spend long periods in front of a computer can make a big difference to torn rotator cuff symptoms by reducing the pressure and friction on the tendon. Check out our top tips on how to improve posture
  
  
• Steroid Injections: your doctor may recommend a steroid injection to help reduce your torn rotator cuff symptoms.  A mixture of local anaesthetic and corticosteroid is injected into the shoulder to help reduce pain and inflammation.  You can find out more about how steroid injections work on our sister site.

There is no quick fix for torn rotator cuff symptoms and it can take a few months for things to settle down, so it is important to persevere with treatment.