Rotator cuff injuries can be traumatic or atraumatic. Regardless of how your shoulder pain starts, it is important to consider what could be contributing to your discomfort. So how can you tell the difference between if you have a rotator cuff strain or if you have something more serious like a rotator cuff tear? Understanding the nuances between a rotator cuff strain and a tear is foundational and can influence the approach to treatment. A strain might result from overuse or a minor injury. Conversely, a tear, whether from acute trauma or normal wear and tear, presents a more serious challenge. Navigating the differences between these issues is critical for achieving effective, long-term pain relief and recovery. This post will address what the rotator cuff is, signs and symptoms of a rotator cuff strain vs a tear, and what to expect for treatment of both.
Go straight to finding out the difference between a rotator cuff strain vs tear.
**This is not medical advice. Please consult your medical provider for more information.
Understanding the Rotator Cuff
The rotator cuff is a crucial part of the shoulder. It is comprised of a group of four different muscles within the shoulder. The four muscles that make up the rotator cuff are supraspinatus, infraspinatus, teres minor, and subscapularis.
This complex structure’s significance is to provide movement of the shoulder and keep the arm bone (the humerus) firmly within the socket. It is also instrumental in maintaining the stability of the shoulder joint. Every time you reach out to grab something or throw a pitch, the rotator cuff is hard at work.
In fact, rotator cuff injuries are one of the most common injuries treated by physical therapists.
“Shoulder pain affects approximately 16% to 21% of the population and is second only to low back pain in prevalence of musculoskeletal conditions.”3
Tate et al.
Signs and Symptoms of a Rotator Cuff Strain
Rotator cuff injuries are common in individuals over the age of 30. Rotator cuff strains and tears can be traumatic or atraumatic. It is very common for these injuries to occur over time due to normal wear and tear. These are commonly referred to as degenerative tears. For a traumatic tear, there is usually an incident that occurs that someone can recall when their pain immediately started.
Individuals who hold jobs in manual labor or commonly perform repetitive motions overhead are more prone to shoulder injuries, including rotator cuff tears. This includes overhead athletes, such as baseball, basketball, and volleyball players, construction workers and electricians.
If there is a specific injury that occurred, you may feel a “popping” sensation around the shoulder. Swelling may or may not be present. If a complete tear is present, you may not be able to move your arm or keep your arm raised if someone lifts it up for you. Pain may not be present if you have a complete tear, however you could have varying degrees of pain if a strain or partial tear occurs.
Other Signs and Symptoms of a Rotator Cuff Injury
- “popping” sensation at the time of injury
- difficulty raising your arm or keeping it raised
- pain along the top or side of the shoulder
- pain at night
- shoulder weakness
Grading of a Rotator Cuff Strain/Tear
The severity of a muscle strain is determined by the “grade” and this helps predict the length of time needed to recover.
- Grade I: mild injury; a few number of muscle fibers torn resulting in mild pain with functional activities like walking and going up/down stairs; range of motion is usually not affected; typically heals in a few days to a couple weeks
- Grade II: moderate injury; a more significant number of muscle fibers torn resulting in moderate pain and loss of range of motion and subsequent weakness; typically takes several weeks to heal
- Grade III: severe injury; complete tearing of the muscle fibers; bruising is very likely and sometimes a gap in the muscle is observable; typically takes several months to heal
It is important to note that some rotator cuff tears may not be painful. The severity of the tear does not always correlate with pain. Full-thickness (complete) tears typically cause minimal to no pain, whereas partial-thickness (partial) tears are usually more painful.
In fact, people can have a rotator cuff tear and not experience any pain. In a study by Tempelhof et al, out of 411 pain-free individuals, 23% of them were found to have rotator cuff tears. This study also found that 13% aged 50-59 had tears, 20% aged 60-69 had tears, 31% aged 70-79 had tears, and 51% of those over 80 had tears.4 This shows that the prevalence of rotator cuff tears increases as age increases.
How Do I Know If I Have a Torn Rotator Cuff?
The initial step in finding out if you have a torn rotator cuff is to meet with an orthopedic specialist. A medical history will be taken and a physical examination will be performed. If the orthopedic specialist believes you could have a tear, an MRI will provide confirmation through detailed imaging.
On occasion, physical therapists can catch rotator cuff tears in the clinic through a series of performed special tests that show us an increased likelihood of a tear. This combined with symptoms from the patient can suggest a reason to go back to your doctor and to get an MRI for confirmation.
Treatment Options for Rotator Cuff Strains and Tears
Conservative treatment is the way to start with rotator cuff tears and strains. For minor strains, a little bit of rest may be enough for the shoulder to heal without further intervention. But for those with either a partial or full-thickness tear, treatment options might not seem as straightforward.
In most cases, conservative treatment of rotator cuff tears start and end with physical therapy. Rotator cuff strains and tears respond favorably to physical therapy. In one study, Kukkonen et al. found that exercise is as effective as surgery in partial-thickness rotator cuff tears (and was a fraction of the cost of surgery).2 On top of that, Kuhn et al. found that exercise significantly reduces the need for surgery in 75% of atraumatic full thickness rotator cuff tears with follow up through two years.1
On occasion, corticosteroid injections may be needed to help mitigate pain. This can be helpful if pain levels are getting in the way of your daily activities and physical therapy exercises, keeping you from progressing. With reduced pain levels from the injections, this allows you to be able to participate more in physical therapy, allowing you to lead a road to recovery.
However, there are cases where surgical intervention is the best option. There are also cases when surgery becomes an option when conservative treatment with physical therapy fails. If this is the case, surgery can repair the rotator cuff tear. Then back to physical therapy you go!
Surgical Interventions for Rotator Cuff Tear
Surgery for a rotator cuff tear aims to repair the torn tendon(s), restoring shoulder stability and function. This usually involves a minimally invasive technique. A tailored rehabilitation program will start a few weeks after surgery focusing on gradually regaining strength and mobility, ensuring a return to optimal arm and shoulder function.
Other Articles Related to Shoulder Strengthening
- 5 Important Shoulder Rehab Exercises for Optimal Function
- Shoulder Strength and Stability: A Beginner’s Guide
- The Exercise You Need for Pinching in Shoulder When Reaching
- Physical Therapy Exercises for Shoulder Pain: What You Should Know
- 5 Best Shoulder Strengthening Exercises for Healthy Movement and Stability
Rehabilitation and Recovery
Rehabilitation with physical therapy is very important after rotator cuff repairs. Physical therapists are aware of the protocols needed to follow in order to ensure safe recovery after surgery and not allowing any further injury to occur to the shoulder as it heals. It is paramount, especially in the first six weeks, to allow the repaired tendons to heal and adhere where they have been anchored.
Post-operative care typically begins with gentle, controlled physical therapy exercises, slowly advancing towards more difficult activities as healing progresses. Throughout this period, the focus remains on minimizing pain while maximizing the shoulder’s strength and stability.
Regardless of the treatment path, it’s vital to engage in a dedicated rehabilitation program. Regular consultations with your orthopedic specialist, along with adherence to a personalized exercise and recovery program through your physical therapist, are fundamental steps to ensure a successful recovery from a rotator cuff repair.
When to See an Orthopedic Specialist
It is not always clear when to find your way to a specialist. Yet, knowing when to seek professional help by an orthopedic specialist can be effective measure when trying to make your way back to effective, long-term pain relief. If you’re experiencing persistent pain, significant and sudden loss of arm movement, or if your shoulder fails to improve with conservative treatment, it’s time to consult. Further follow up with an orthopedic specialist can shine light on whether you’re facing a rotator cuff strain or a more serious rotator cuff tear. Timely intervention could help you avoid surgery. However, in instances when surgery is required, the sooner the better. Because shortly after your surgery, you will be able to start attending physical therapy where you will regain normal function of your shoulder. And regaining normal function means getting back to doing what you love.
Preventing Future Rotator Cuff Injuries
While injuries are not fully preventable, there are things you can do to help. Engaging in a regular exercise routine helps keep your muscles strong. Specific physical therapy exercises can make sure you are engaging the muscles of the rotator cuff, keeping proper alignment, and maintaining form which really targets strengthening of the rotator cuff. Performing lateral raises and shoulder presses in your regular gym workout won’t be enough for the rotator cuff.
Shoulder dysfunction early on can start with impingement-like symptoms. This can signal to start paying attention to the shoulder and beginning a rehab regimen. Shoulder impingement typically occurs with muscle imbalances. Muscle imbalances can further lead to possible rotator cuff strain or tear. However, just because you have shoulder impingement does not mean you will develop a rotator cuff tear. Remember, rotator cuff tears can occur over time due to normal wear and tear. The shoulder is a very mobile joint and requires a lot of stability. If muscle imbalances are present, it increases the likelihood of injury to occur.
Take your shoulder health into your own hands. You can help prevent further degeneration and facilitate a return to normal function at the onset of pain or begin a prehab program for injury prevention. Click here to find out how you can work with me, a physical therapist, to kickstart your rehab or prehab shoulder journey.
References
- Kuhn JE, Dunn WR, Sanders R, et al. Effectiveness of physical therapy in treating atraumatic full-thickness rotator cuff tears: a multicenter prospective cohort study. J Shoulder Elbow Surg. 2013;22(10):1371-1379. https://pubmed.ncbi.nlm.nih.gov/23540577/. doi:10.1016/j.jse.2013.01.026
- Kukkonen J, Joukainen A, Lehtinen J, et al. Treatment of non-traumatic rotator cuff tears: A randomised controlled trial with one-year clinical results. Bone Joint J. 2014;96-B(1):75-81. https://pubmed.ncbi.nlm.nih.gov/24395315/. doi:10.1302/0301-620X.96B1.32168
- Tate AR, McClure PW, Young IA, Salvatori R, Michener LA. Comprehensive impairment-based exercise and manual therapy intervention for patients with subacromial impingement syndrome: a case series. J Orthop Sports Phys Ther. 2010;40(8):474-493. https://pubmed.ncbi.nlm.nih.gov/20710088/. doi:10.2519/jospt.2010.3223
- Tempelhof S, Rupp S, Seil R. Age-related prevalence of rotator cuff tears in asymptomatic shoulders. J Shoulder Elbow Surg. 1999;8(4):296-299. https://pubmed.ncbi.nlm.nih.gov/10471998/. doi:10.1016/s1058-2746(99)90148-9
TL;DR
Rotator cuff injuries can be traumatic or atraumatic. A strain might result from overuse or a minor injury. Conversely, a tear, whether from acute trauma or normal wear and tear, presents a more serious challenge. Navigating the differences between these issues is critical for achieving effective, long-term pain relief and recovery. This post addresses what the rotator cuff is, signs and symptoms of a rotator cuff strain vs a tear, and what to expect for treatment of both.
