Shoulder impingement is a very common cause of shoulder pain, where a tendon (band of tissue) inside your shoulder rubs or catches on nearby tissue and bone as you lift your arm. It affects the rotator cuff tendon, which is the rubbery tissue that connects the muscles around your shoulder joint to the top of your arm.
- 0.1 What is the test for a torn rotator cuff?
- 0.2 Where is the pain felt with a rotator cuff injury?
- 1 How long should my shoulder hurt before I see a doctor?
When should I be concerned about shoulder pain?
Schedule an office visit – Make an appointment with your doctor if your shoulder pain is accompanied by:
- Tenderness and warmth around the joint
Will a rotator cuff tear heal by itself?
Will a rotator cuff tear heal on its own? – In most cases, a rotator cuff tear will not heal on its own. If your pain and other symptoms persist despite conservative treatment such as steroid injections and physical therapy, it’s time to speak with a shoulder specialist.
What is the test for a torn rotator cuff?
Imaging tests – A doctor might request one of several imaging tests to diagnosis your torn rotator’s cuff such as an x-ray, ultrasound, or magnetic resonance imaging (MRI).
X-rays won’t show a torn rotator cuff but can rule out other causes of pain, such as bone spurs. Ultrasounds can be used to monitor the muscle and tendons while you move your arm and compared to your other arm. MRIs use radio waves to create a picture of the bone, muscles, and connective tissue in your shoulder.
Where is the pain felt with a rotator cuff injury?
The rotator cuff is a group of four muscles that come together as tendons to form a “cuff,” or cover, over the head of the humerus (upper arm bone). The four muscles — supraspinatus, infraspinatus, subscapularis and teres minor — originate from the scapula (shoulder blade).
Typically, you will feel pain in the front of your shoulder that radiates down the side of your arm. It may be present with overhead activities such as lifting or reaching (e.g., serving in tennis, painting a ceiling). You may feel pain when you try to sleep on the affected side. You may note weakness of your arm and difficulty with routine activities such as combing your hair or reaching behind your back. If the tear occurs with injury, you may experience acute pain, a snapping sensation, and immediate weakness of the arm.
A rotator cuff tear can extend or get larger over time. This can occur normally over time, or with repetitive use or a re-injury. It is common for patients with known rotator cuff disease to have acute pain and weakness following a minor injury. This likely represents extension of an existing tear.
- If you know you have a rotator cuff tear, worsening pain and decreasing strength may mean the tear is getting larger.
- If you have injured your shoulder or have chronic shoulder and arm pain, it is best to see an orthopaedic surgeon.
- They can then make a diagnosis and begin treatment.
- Your doctor may recommend a diagnostic imaging study such as a magnetic resonance imaging (MRI) scan or ultrasound to confirm the diagnosis.
Early diagnosis and treatment of a rotator cuff tear may prevent symptoms such as loss of strength and loss of motion from setting in. If your primary physician has already made the diagnosis, an orthopaedic surgeon can review both surgical and nonsurgical options and start treatment.
Anti-inflammatory medications Steroid (cortisone) injections Physical therapy
The goals of treatment are to relieve pain and restore strength to the involved shoulder. Even though most tears cannot heal on their own, you can often achieve good function without surgery. If, however, you are active or use your arm for overhead work or sports, surgery is most often recommended because many tears will not heal without surgery. Surgery is recommended:
If you have persistent pain or weakness in your shoulder that does not improve with nonsurgical treatment. Frequently, patients who require surgery will report pain at night and difficulty using the arm for lifting and reaching. Many will report ongoing symptoms despite several months of medication and limited use of the arm. In active individuals who use the arm for overhead work or sports. Pitchers, swimmers, and tennis players are common examples.
Additionally, surgery may be recommended for complete tears that are acute and due to a trauma. The type of repair performed is based on the findings at surgery.
A partial tear may require only a trimming or smoothing procedure called a débridement. A full-thickness tear, which usually means the tendon is torn from its insertion on the humerus (the most common injury), is repaired directly to bone.
Three techniques are used for rotator cuff repair:
Traditional open repair Mini-open repair Arthroscopic repair
Your orthopaedic surgeon can recommend which technique is best for you. Rehabilitation plays a critical role in both the nonsurgical and surgical treatment of a rotator cuff tear. When a tear occurs, there is frequently atrophy of the muscles around the arm and loss of motion of the shoulder.
An exercise or physical therapy program is necessary to regain strength and improve function in the shoulder. After surgery, the repair must be protected from certain activities that may put healing at risk. As such, a therapist can provide a safe and progressive therapy program. Even though surgery repairs the defect in the tendon, the muscles around the arm remain weak, and a strong effort at rehabilitation is necessary for the procedure to succeed.
Complete rehabilitation after surgery may take several months or even up to a year. Your orthopaedic surgeon can prescribe an appropriate program based on your needs and the findings at surgery.
How long should my shoulder hurt before I see a doctor?
When to Schedule Your Appointment – You should see an orthopedic doctor if your elbow or shoulder pain :
lasts more than four weeks, does not start feeling better within two to four weeks, or gets progressively worse day to day or week to week.
What does bursitis in the shoulder feel like?
You may experience a dull ache, sharp pain or mild tenderness. Other signs of shoulder bursitis include: Shoulder stiffness or a feeling of swelling. Painful range of motion.
Can you see a rotator cuff tear on xray?
Diagnosis – During the physical exam, health care providers will press on different parts of the affected shoulder and move your arm into different positions. They’ll also test the strength of the muscles around your shoulder and in your arms. Imaging tests may include:
X-rays. Although a rotator cuff tear won’t show up on an X-ray, this test can visualize bone spurs or other potential causes for your pain — such as arthritis. Ultrasound. This type of test uses sound waves to produce images of structures within your body, particularly soft tissues such as muscles and tendons. It allows a provider to assess the structures of your shoulder during movement. It also allows a quick comparison between the affected shoulder and the healthy shoulder. Magnetic resonance imaging (MRI). This technology uses radio waves and a strong magnet. The images obtained display all structures of the shoulder in great detail.
What should you not do with a rotator cuff injury?
Overhead Lifts – During the recovery phase of a rotator cuff injury, avoiding overhead lifts with any weight is highly recommended. Movements that require the shoulders to be put under intense pressure or performing complex motions will put more strain on the muscles and potentially cause more significant injury.
Does a torn rotator cuff hurt all the time?
The rotator cuff is a group of muscles and tendons that attach to the bones of the shoulder joint, allowing the shoulder to move and keeping it stable.
Rotator cuff tendinitis refers to irritation of these tendons and inflammation of the bursa (a normally smooth layer) lining these tendons.A rotator cuff tear occurs when one of the tendons is torn from the bone from overuse or injury.
The shoulder joint is a ball and socket type joint. The top part of the arm bone (humerus) forms a joint with the shoulder blade (scapula). The rotator cuff holds the head of the humerus into the scapula. It also controls movement of the shoulder joint. TENDINITIS The tendons of the rotator cuff pass underneath a bony area on their way to attaching the top part of the arm bone. When these tendons become inflamed, they can become more inflamed over this area during shoulder movements. Sometimes, a bone spur narrows the space even more. Rotator cuff tendinitis is also called impingement syndrome. Causes of this condition include:
Keeping the arm in the same position for long periods, such as doing computer work or hairstylingSleeping on the same arm each nightPlaying sports requiring the arm to be moved overhead repeatedly such as in tennis, baseball (particularly pitching), swimming, and lifting weights overheadWorking with the arm overhead for many hours or days, such as in painting and carpentryPoor posture over many yearsAgingRotator cuff tears
TEARS Rotator cuff tears may occur in two ways:
A sudden acute tear may happen when you fall on your arm while it is stretched out. Or, it can occur after a sudden, jerking motion when you try to lift something heavy.A chronic tear of the rotator cuff tendon occurs slowly over time. It is more likely when you have chronic tendinitis or impingement syndrome. At some point, the tendon wears down and tears.
There are two types of rotator cuff tears:
A partial tear occurs when a tear does not completely sever the attachments to the bone.A complete, full thickness tear means that the tear goes all the way through the tendon. It may be as small as a pinpoint, or the tear may involve the entire tendon. With complete tears, the tendon has come off (detached) from where it was attached to the bone. This kind of tear does not heal on its own.
TENDINITIS Early on, pain is mild and occurs with overhead activities and lifting your arm to the side. Activities include brushing your hair, reaching for objects on shelves, or playing an overhead sport. Pain is more likely in the front of the shoulder and may travel to the side of the arm. Over time, there may be pain at rest or at night, such as when lying on the affected shoulder. You may have weakness and loss of motion when raising the arm above your head. Your shoulder can feel stiff with lifting or movement. It may become more difficult to place the arm behind your back.
ROTATOR CUFF TEARS The pain with a sudden tear after a fall or injury is usually intense. Right after the injury, you will likely have weakness of the shoulder and arm. It may be hard to move your shoulder or raise your arm above the shoulder. You may also feel snapping when trying to move the arm. With a chronic tear, you often do not notice when it began.
This is because symptoms of pain, weakness, and stiffness or loss of motion worsen slowly over time. Rotator cuff tendon tears often cause pain at night. The pain may even wake you. During the day, the pain is more tolerable, and usually only hurts with certain movements, such as overhead or reaching toward the back. Over time, the symptoms become much worse, and are not relieved by medicines, rest, or exercise.
A physical examination may reveal tenderness over the shoulder. Pain may occur when the shoulder is raised overhead. There is often weakness of the shoulder when it is placed in certain positions. X-rays of the shoulder may show a bone spur or change in the position of the shoulder. It can also rule out other causes of shoulder pain, such as arthritis.
Your health care provider may order other tests:
An ultrasound test uses sound waves to create an image of the shoulder joint. It can show a tear in the rotator cuff. MRI of the shoulder may show swelling or a tear in the rotator cuff. With a joint x-ray ( arthrogram ), the provider injects contrast material (dye) into the shoulder joint. Then an x-ray, CT scan, or MRI scan is used to take a picture of it. Contrast is usually used when your provider suspects a small rotator cuff tear.
Follow your provider’s instructions on how to take care of your rotator cuff problem at home, Doing so can help relieve your symptoms so that you can return to sports or other activities. TENDINITIS Your provider will likely advise you to rest your shoulder and avoid activities that cause pain. Other measures include:
Ice packs applied 20 minutes at a time, 3 to 4 times a day to the shoulder (protect the skin by wrapping the ice pack in a clean towel before applying)Taking medicines, such as ibuprofen and naproxen, to help reduce swelling and painAvoiding or reducing activities that cause or worsen your symptomsPhysical therapy to stretch and strengthen the shoulder muscles Medicine (corticosteroid) injected into the shoulder to reduce pain and swellingSurgery ( arthroscopy ) to remove inflamed tissue and part of the bone over the rotator cuff to relieve pressure on the tendons
TEARS Rest and physical therapy may help with a partial tear if you do not normally place a lot of demand on your shoulder. Surgery to repair the tendon may be needed if the rotator cuff has a complete tear. Surgery may also be needed if the symptoms do not get better with other treatment.
Most of the time, arthroscopic surgery can be used. Large tears may need open surgery (surgery with a larger incision) to repair the torn tendon. With rotator cuff tendinitis, rest, exercise and other self-care measures often improve or even relieve symptoms. This may take weeks or months. Some people may need to change or reduce the amount of time they play certain sports to remain pain-free.
With rotator cuff tears, treatment often relieves symptoms. But outcome depends on the size of the tear and how long the tear has been present, the person’s age, and how active the person was before the injury. Call for an appointment with your provider if you have ongoing shoulder pain.
- Also call if symptoms do not improve with treatment.
- Avoid repetitive overhead movements.
- Exercises to strengthen shoulder and arm muscles can also help prevent rotator cuff problems.
- Practice good posture to keep your rotator cuff tendons and muscles in their right positions.
- Swimmer’s shoulder; Pitcher’s shoulder; Shoulder impingement syndrome; Tennis shoulder; Tendinitis – rotator cuff; Rotator cuff tendinitis; Shoulder overuse syndrome Hsu JE, Gee AO, Lippitt SB, Matsen FA.
The rotator cuff. In: Rockwood CA, Matsen FA, Wirth MA, Lippitt SB, Fehringer EV, Sperling JW, eds. Rockwood and Matsen’s The Shoulder,5th ed. Philadelphia, PA: Elsevier; 2017:chap 14. Mosich GM, Yamaguchi KT, Petrigliano FA. Rotator cuff and impingement lesions.
- In: Miller MD, Thompson SR, eds.
- DeLee and Drez’s Orthopaedic Sports Medicine: Principles and Practice,5th ed.
- Philadelphia, PA: Elsevier; 2020:chap 47.
- Updated by: C.
- Benjamin Ma, MD, Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA.
- Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M.
What is the best test for rotator cuff tear?
, This can be useful when diagnosing sub-acromial pain syndrome (shoulder impingment) or to differentiate between shoulder and rotator cuff pathologies.