It's well known by health practitioners who pay attention to the literature that there are a lot of people living their lives with tears in their rotator cuff tendons without pain or affected function.
It is well known that many people in the general population have an asymptomatic rotator cuff tear4-6. Patients may become asymptomatic following rotator cuff repair despite evidence that the repair failed on magnetic resonance imaging (MRI) or ultrasound imaging7.
Patients with “well-balanced” massive rotator cuff tears may still have good active motion and be able to perform their activities of daily living.
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.
Delaying treatment of a torn rotator cuff can increase the risk of the shoulder sustaining even more damage because the tendons and muscles cannot heal properly. The overused muscles will start fraying, and additional tears can develop.
Typically tears occur in those over age 40, but occasionally tears are seen in younger individuals. Typical signs of a rotator cuff tear include pain with overhead use of the arm, weakness or pain preventing or disrupting sleep.
Rotator cuff tears usually produce symptoms of weakness and pain especially on trying to lift the arm. When an acute injury results in a rotator cuff tear consideration should be given to a surgical repair within six weeks of the injury to avoid atrophy of the muscle and tendon.
Without any treatment—either rest and rehabilitation or surgery—rotator cuff disorders may get worse. Over time, you may have more pain. You may lose range of motion and strength in your shoulder, making it harder to do your daily activities.
Those are small to medium tears. Patients still have the ability to raise their arm, and they can still do day-to-day things, but they tend to have some pain. So, being able to use the arm and move it and raise it above your head does not necessarily mean that the rotator cuff is intact.
If you are very active and use your arms for overhead work or sports, your doctor may also suggest surgery. Other signs that surgery may be a good option for you include: Your symptoms have lasted 6 to 12 months. You have a large tear (more than 3 cm) and the quality of the surrounding tendon tissue is good.
The Lateral Jobe Test is actually one of the most reliable tests for a rotator cuff injury, and you may need an assistant again to help administer this test. This test also looks for weakness in the supraspinatus muscle.
Your symptoms may worsen, especially if you continue to use your arm like normal. Patients may start to feel more apparent, constant, or even debilitating pain. Severe cases of rotator cuff tears can even prevent you from getting proper sleep and rest.
The pain associated with a rotator cuff injury may: Be described as a dull ache deep in the shoulder. Disturb sleep. Make it difficult to comb your hair or reach behind your back.
A complete tear can make it almost impossible to move your arm. Without treatment, you may have chronic shoulder pain and find it very difficult to use the injured arm.
It is very uncommon to operate on a partial rotator cuff tear. In cases of deep partial tears — when more than 90 percent of the tendon is torn — surgery is recommended only if the symptoms can't be controlled with nonsurgical treatments.
It will be difficult to move your arm and shoulder normally if the rotator cuff is torn. Simple tasks like brushing your hair, dressing, and cooking will be excruciatingly painful. You may find it challenging to carry even small objects due to the lack of range of motion.
Ultrasound does have the ability to identify rotator cuff tendon tears but with certain limitations. One factor is that it requires special training for the staff, as this is a less commonly performed imaging test. Second, the tendons may not be adequately seen in obese patients or those with a limited range of motion.
Red flags include: Trauma, pain and weakness, or sudden loss of ability to actively raise the arm (with or without trauma): suspect acute rotator cuff tear. Any shoulder mass or swelling: suspect malignancy. Red skin, painful joint, fever, or the person is systemically unwell: suspect septic arthritis.
Can a rotator cuff injury cause pain in your arm and hand, too? Yes. Typically, the pain starts as a dull aching pain in your shoulder. As the injury progresses, it can cause radiating pain down the arm and into your hands.
The most common symptoms of a rotator cuff tear include: Pain at rest and at night, particularly if lying on the affected shoulder. Pain when lifting and lowering your arm or with specific movements. Weakness when lifting or rotating your arm.
Getting To Sleep With Rotator Cuff Pain
Before heading to bed, try icing your shoulder (or using a heat pack, if you prefer) for between 15 and 20 minutes. This helps to reduce inflammation and ease pain, but remember to wrap your ice/heat pack in a towel; this helps to prevent burning and damage to the skin.
What are the symptoms of rotator cuff tendonitis? The classic symptoms include a 'toothache' like pain radiating from the outer arm to several inches below the top of the shoulder. Pain may also occur in the front and top of the shoulder. It may interfere with sleeping comfortably.
Your doctor may suggest taking a nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen or naproxen, to reduce inflammation and pain. If severe shoulder pain prevents you from participating in daily activities such as going to work, doctors may offer prescription pain relievers for one or two weeks.
Diagnostic imaging is considered to be the gold standard for rotator cuff injuries, particularly MRI, but it has also proven to be highly expensive. The incidence and prevalence of rotator cuff tears increase with age.
Arthroscopic Rotator cuff repair is a great operation that can decrease pain and improve shoulder function. However, it is important to realize that it may not make your shoulder feel 100% normal again.