The fear of the ever-dreaded rotator cuff tear is enough to send one into complete denial. I know this because I’ve had patients who’ve had shoulder pain for years and did nothing about it just because they were “afraid of the rehab”. They’ve heard the typical horror stories about their Uncle Larry’s “rotary cup” surgery taking a year to heal, all the while having to endure months of grueling torture by Stan the “physical terrorist”.

Afraid of the rehab??? Most of the time what was a mild shoulder injury to begin with has now turned into a problem that WILL take surgery and months of therapy to correct. While it is out of the scope of my practice act to diagnose a specific injury, I still attempt to answer a patient’s questions about what a rotator cuff tear feels and acts like, if nothing more than to give them some direction or peace of mind about their shoulder pain.

Rotator cuff tears are usually preceded by some traumatic event, whether it is a lifting action, throwing motion, or some type of event that involves a twist of the shoulder. However there are incidents where a simple “reaching out” can cause a tear. This usually is because the person had a “type III” or “hooked” acromium (sharp point at the end of the clavicle bone) which caused gradual wearing away of the cuff tendon. In either case the person typically describes a sudden sharp pain in the shoulder followed by a burning sensation. The days ahead are followed by extreme shoulder pain and weakness when attempting to lift the arm above shoulder height or possibly just reaching out for an object.

A simple test for a more severe tear is called the “drop arm test”.  The examiner lifts both of the patient’s arms out to their side and instructs them to keep them from dropping. A positive test is when patient is unable to keep the involved arm from dropping down and is typically accompanied by shrugging the same shoulder toward the ear in attempts to keep it by their side.

Smaller tears are more difficult to assess, but can be picked up by a trained examiner. The clinician decides there might be a tear through a combination of the mechanism of injury (was there an event likely to cause a tear), and assessing the strength of the cuff muscle in isolation through specific tests. If there are positive signs then the patient is sent for further tests which may involve a diagnostic injection, or possibly injecting a radiographic dye into the rotator cuff and then examining it under flouroscopy to see if any of the injected medium leaks out.

If a tear is discovered it is crucial to get treatment as soon as possible to avoid further complications and a stiff and painful shoulder requiring frozen shoulder treatment. Very small tears may be treated with cortisone followed by a course of rotator cuff physical therapy. Larger tears will likely need surgical repair.