Dear Dr. Millett,

I have a shoulder injury that is giving me a lot of pain. I haven’t been to my doctor yet and am trying to do some of my own research. What is a rotator cuff tear? What are the symptoms?

Mikel L.

The best way to determine what injury you have, and then what treatment is most appropriate, is to visit your doctor and get an X-ray or an MRI. It is possible you could have a rotator cuff tear, but this will not be known unless you get tested. The rotator ruff, despite the way it sounds, it’s actually a group of four tendons that surround the shoulder joint and work together. The tendons attach the associated four muscles to the bone so that when the muscles contract they help to stabilize and move the shoulder joint. When the rotator cuff is injured, it is actually the tendons that are typically damaged. Injury can range from a mild strain, to chronic inflammation, to a small tear, to a massive tear where all four tendons are involved – typically, the greater the severity of injury the greater the pain and dysfunction that will be present. In some cases however, people can have relatively large tears without significant weakness. This is one reason why it is important to discuss your situation with a trained specialist so that the best treatment can be selected.

The most common symptom of a rotator ruff tear is pain. Most patients will complain of pain along the outside of the shoulder in the deltoid region, while others mention that the pain continues throughout the length of their bicep, down to the elbow. This pain is caused by inflammation of the tendons or the surrounding bursa; swelling is not typically seen. The pain is usually more intense at night and it may wake one from sleep. While pain is most common symptom, weakness of the shoulder is another common finding, particularly with larger tears. This weakness makes lifting the arm overhead very difficult, along with carrying things, getting dressed, and reaching for things.

Because a lot of shoulder injuries have similar symptoms and pain, it is important that you see a physician who can assess the problem. X-rays and an MRI may be needed to help assess the severity of the injury. For active patients and particularly those with acute tears, surgery may be needed. Rotator cuff repairs are very commonly performed surgeries and can help correct the rotator cuff tear or rotator cuff injury. The tendon(s) which are torn are sewn back to the bone and attached there using sutures and specially designed implants called suture anchors (which resemble the pitons used as anchors in ice and rock climbing). This is typically an arthroscopic procedure and other factors such as bone spurs, inflamed bursa (bursitis), and damaged biceps tendons can be addressed.

Recovery is typically 4 months although this varies depending on the size of the tear, the quality of the patient’s tissues, and the security of the surgical repair.