While full thickness rotator cuff tears are very common, let’s back up and start with the basics about these 4 little muscles. The rotator cuff plays a key role in the proper function of the shoulder. The four muscles which make up the “rotator cuff” are under a lot of stress. They need to maintain proper function of the shoulder. If the cuff sees too much stress they can become inflamed, or start to tear. Age or activity related degeneration can also leave our rotator cuff at risk of injury. The rotator cuff can be a source of pain for many many reasons.
Your shoulder pain can be due to:
- inflammation of the rotator cuff
- degeneration (tendinosis) of the rotator cuff
- tears of the rotator cuff.
Tears of the rotator cuff come in all shapes and sizes. Fraying of the rotator cuff tendon surface, partial thickness tears, and full thickness rotator cuff tears are all quite common. Interestingly, the degree of damage seen on the MRI does not predict how severe your pain will be. That means that there are some of you with small rotator cuff tears, or no rotator cuff tear, yet you have severe shoulder pain. On the other hand, there are many people with large full thickness rotator cuff tears who have very little pain. It can be confusing.
How do Orthopedists figure out which type of rotator cuff problem you have and how does that effect our treatment plan for your shoulder pain?
Rotator Cuff Tears:
Before we delve briefly into whether or not you have a full thickness rotator cuff tear (complete tear),you need to know what the rotator cuff is.
The rotator cuff is a series of four muscles, which combine at the shoulder to form a cuff of tissue completely surrounding the top of the arm bone or humerus.
Rotator cuff tears can be described in many different ways.
- There are traumatic tears (accident or a fall), acute tears (just happened)
- Chronic tears (present for a while, you just didn’t know it)
- Degenerative tears ( your tendon just wore out).
Rotator cuff tears can also be described as being partial, or full thickness. With partial thickness rotator cuff tears only part of the tendon has torn off the bone. With full thickness tears the entire tendon has separated or torn from the bone. Click here to learn about partial thickness tears.
Can you tell if you have a full thickness rotator cuff tear?
After a significant trauma such as a fall or a car accident, your rotator cuff tendon can literally pull right off the bone. We call that an acute, traumatic full-thickness rotator cuff tear. On the other hand, I see many patients in the office who do not recall any significant injury, but their exam and MRI demonstrate that they have a full thickness tear — why is that? The risk of developing a rotator cuff tear increases with age because our tendons begin to gradually wear, lose its blood supply and its resilience. In that situation, even routine daily activities like gardening or working around the house increase the potential for wear, degeneration, and tearing.
Whether your tear is chronic, attritional (wear and tear) or acute and traumatic (fall or injury) is a VERY important element of the decision-making process in how we treat full-thickness rotator cuff tears. Treatment decisions are based not only on the type of tear you have, but whether or not other treatments have failed, and how poor your quality of life is.
Rotator cuff tears, whether acute or chronic can cause severe pain. Many of you report temporary relief using:
- A shoulder ice sleeve
- A shoulder compression sleeve
- A Shoulder support pillow to help you sleep at night
- A sling to support the arm
Full thickness rotator cuff tears
Rotator cuff tears come in all shapes and sizes. Many patients have full thickness rotator cuff tears and do not even know it. As a matter of fact, by the time you reach 65 you have more than a 50% chance of having a degenerative rotator cuff tear because of wear and tear. No need to panic…
>How can Orthopedic Surgeons tell if you have a full thickness rotator cuff tear?
Shoulder Pain:
Does the amount of pain you are having correlate with the size or thickness of your rotator cuff tear?
The size of the tear usually doesn’t correlate with the pain you are experiencing. Many patients mistakenly believe that they must have a large full thickness rotator cuff tear because they are in severe pain … usually, the opposite is true. Many patients with severe shoulder pain have very small full thickness rotator cuff tears, partial thickness rotator cuff tears, or no tear at all. Yet some patients with mild shoulder pain have massive rotator cuff tears. Bottom line… the size of your tear will not correlate with the amount of pain you are experiencing. Many patients with tendonitis or bursitis have more pain than patients with rotator cuff tears. Many patients with tendinosis, small tears, large tears or just bursitis usually have very severe pain at night. Night pain can be very disruptive, aggravating and demoralizing. Night pain is frequently the reason many patients cite why they opted for surgery to repair a full thickness rotator cuff tear.
Weakness:
The rotator cuff muscles control the motion and the overall strength of the shoulder. Small tears do not produce shoulder weakness, however, large or massive tears can produce very significant shoulder weakness.
Patients with large rotator cuff tears complain of weakness and the inability to place the arm in certain positions. They have difficulty taking milk out of the refrigerator and may need to support their injured arm with their other arm when attempting to lift something.
Do you have questions regarding an Orthopedic injury or longevity?
Do you want to talk to an expert who can listen to you for 45-60 minutes and explain the options in detail?
Dr. Howard Luks offers remote guidance sessions to review your X-ray or MRI images and explain your options.
Dr. Luks has also received hundreds of requests for educational sessions on the topics discussed in his book, Longevity Simplified.
Loss of motion:
Most rotator cuff conditions which produce pain will lead to loss of motion. Many patients with rotator cuff related pain will complain of difficulty with hair care, putting on a bra or belt, and weakness when trying to lift the arm away from the side. Sometimes patients with full-thickness tears will have significant loss of motion, and sometimes patients with large rotator cuff tears will have normal motion. That means that loss of motion, in general, is a poor predictor in and of itself of the presence of a full thickness rotator cuff tear.
A thorough physical examination by a Sports Medicine trained specialist is usually necessary to determine whether a rotator cuff tear is present.
Ultimately an MRI or an ultrasound may be necessary to confirm the presence and size of a rotator cuff tear and determine if it is partial thickness or a full thickness rotator cuff tear.
Whether you have a full thickness tear or a partial thickness tear, your shoulder pain may be so severe that your quality of life is very poor. You’re not sleeping well and you have very limited use of your arm. Not all rotator cuff tears require surgery… but some do.
There are affiliate links on this page. Please see my disclaimer
Jamie
Hi – i am a 64 year old female who is very active. Golf, yoga, hiking, etc. I’m scheduled for surgery Sept. 4, 2019. My MRI dated June 29 shows a “1cm full-thickness tear or extremely high grad partial-thickness tear of the critical zone of the supraspantus tendon”. My Ortho says it is a full thickness tear. This most likely happened from playing golf. Started having pain in my left shoulder about a month prior to the MRI, tried to ignore it and pushed myself through it. I have done some PT, no injections and have had steady improvement of pain, ROM and weakness. However my ROM is still limited and I still have weakness. I don’t have a lot of pain, unless I overdue it. More soreness and deep aches than anything. Although I do have a “hot spot” where the long head of the biceps tendon intersects with the suprspantus tendon. I’ve also consulted with two regenerative specialists that in reviewing my records and looking at the area via ultrasound feel I would benefit from Stem Cells/PRP. They both agreed that it was a full tear but one said it was a .2 cm retraction and the other said minimal retraction. They felt that there was a good chance the tendon could heal with biologics. What are your thoughts on this? Would like to avoid the surgery if at all possible but also want to get back to golf and my active lifestyle and be able to function normally. Is the surgery necessary? My surgeon says I have a 95% success rate if I fix it now otherwise I risk tearing it further in the future with less of a chance to heal. He feels it’s best to get it done now because I am so active. Thank you for your consideration!
Michael Martin
Dr,
I was diagnosed with a full tear of Supraspinatus in right shoulder. Dr say’s not sure he can repair. He went on to say that replacements( both Flavors) have no better odds of repair. Question: Would (Superior Capsular Reconstruction) SCR be an option?
Thanks
Hi Michael, Many isolated supraspinatus (SST) tears can be repaired. An SCR is usually reserved for those with a larger defect… however I’m sure there are docs performing an SCR for an irreparable SST. Then again, based on your age, activity level and so on that may or may not be a good option for you. I would virtually never recommend a reverse, hemi, or total shoulder for someone with an isolated SST tear.
ANEEZ
Am 40 age male,playing football twice a week.while playing on last january 25th 2019 ,i fall down and after 30 minutes paining starts on shoulder.. kept ice full night.morning i cant lift my left hand..
consult doctor .he told rotatory cuff is injured
ultra sound scan result is as follows😢😢
—————supraspinatus tendon shows full tickness tear anteriorly with tendon retraction of upto 1cm and
bursal surface partial tear posteriorly
—————–subscapularis and infraspinatus tendond are intact
—————–long and short head of biceps are intact.biseps tendon is well seated intertubsecular
groove
doing some physiotherapic exercise
still civiar pain while sleeping and cant lift horizntaly
what is the next to do?
if surgery
How long does it take for rotator cuff to heal
please help
The recovery from a rotator cuff repair can take many months. The tendon starts to heal within 6-8 weeks but it takes much longer until it starts to get back its near normal strength.
Mike
Hi – was reading through some of these – 27 year old here, fell hard on my shoulder during a tough mudder event.. below my shoulder blade some scratches but no bruising.. i believe it could be my infraspinatus… injury happened on 8.19 – have full motion although some motions do cause some pain.. i figured i should try and rest, no lifting heavy things and some icing.. am i right to wait a week or two and see if it improves? or should i be doing some stretching or anything?
thanks
Carol
53 yo F, overweight, low level of exercise. I fell about 6 weeks ago. Tried chiropractor twice but pain continued, so I saw a NP at the orthopedic dr. that has done 6 surgeries on my feet and ankles (torn achilles X2, heel spurs, broken foot), so I am a fairly regular pt. MRI said “focal high grade near full thickness tear involving the anterior fibers of the supraspinatus tendon measuring 8 mm in size and partial thickness interstitial tearing involving the superior fibers of the subscapularis tendon”.
I was not able to see the Dr, just the NP, but she said he recommended PT and come back in a month. Pain is tolerable and near constant. ROM is limited.
Can PT fix this? Or am I just wasting time before the inevitable? About 30 years ago, I tore the other RC and had surgery on it, and it was no where near as painful, although ROM was worse.
Thanks in advance.
PT can result in resolution of your pain… and PT for these small degenerative rotator cuff tears is the recommended first step in treatment.
David Noel
Is this the same as a fully torn supraspinatus
THe supraspinatus is just one of the four rotator cuff muscles. So, yes… you can have a full tear of just the supraspinatus in isolation.
john
Hello. I have had rotator cuff pains since high school. Never anything too bad but definitely something going on. Well 5 weeks ago i fell off of a ladder and broke the clavicle on the same shoulder. Now I have way more pain in the rotator cuff and it seems to have expanded if that makes any sense. Should i be worried ?
I wouldn’t necessarily be worried… but I would have your doctor assess the status of your rotator cuff on exam after your clavicle fracture has healed.
dave
Hello Doctor,
My arm has been bothering me for a couple years, currently I am not able to sleep through the night and am unable to lift weights without pain in my shoulder. My MRI revealed a high-grade insertional interstitial tear of the anterior supraspinathus 9X9 mm. My orthopedic surgeon says surgery, any other thoughts/suggestions?
Thank you.
These small degenerative tears of the supraspinatus (one of the rotator cuff tendons) are very common. Most of the research out there shows that many patients will do very well with physical therapy. If PT, injections, time and perhaps some medication do not improve symptoms then many of us will consider surgery as a final treatment.
Ktt
If the deltoid muscle has “slid” down from the shoulder into the bicep/tricep area does this indicate rotor cuff injury or simply the result of immobilization after injury, such as a blow to the shoulder?
Joanne Jess
I have a full thickness, complete rotator cuff tear. I’ve seen 2 surgeons who say “because it’s a chronic tear and I waited too long, I’m not eligible for surgery because they don’t think it will stretch back”. I’m only 54 and in a lot of pain. Apparently my socket is smaller than normal and that’s why it’s torn at such a young age. Any ideas. Thanks
There are other ways to try and improve your pain. They are very tricky and require experienced hands. Treating people with chronic, retracted tears of the rotator cuff with fatty atrophy is challenging. You would need to find an experienced shoulder specialist.
You would need to ask if they perform:
1. Superior Capsule Reconstructions
2. Tendon transfers
3. Patches or allograft reconstructions with a Graft Jacket.
These are very difficult, “big” procedures…. but there is published literature on their success in minimizing pain due to chronic rotator cuff tears.
Good Luck
Ktt
About 9 weeks ago I fell from a bicycle directly on my shoulder. The x-rays revealed a fractured my proximal humerus. Starting about week 4 I started to get severe soreness in my shoulder that wakes me up, usually 2 to 6 hours after I go to sleep. It gets much better when I get up and move around. The bone break is or close to healed by now.
I asked my doctor what this night pain is and if it could be a rotor cuff problem. He said it’s normal soreness from the fracture which will go away and that he does not think I have a rotor cuff injury. Is this true? I now can move my arm straight up to about 110 degrees (up from 0 the first weeks) but the pain at night is terrible and it is not getting better. What do you think?
Hard to say… it is not uncommon for pain to persist following a fracture, but that residual pain can be due to a rotator cuff injury. If PT, stretching does not improve the pain I will usually image the rotator cuff (ultrasound or MRI)
Ktt
Thank you for your prompt reply. One thing I forget to add is that what appears to be a muscle that is part of my deltoid (that wraps around the side and back to the front?) looks swollen and like it has “slipped down” into the center of my humerus between the bicep and tricep meet. When I straighten my arm it goes back up into the deltoid. Is this simply part of the fallout from the fracture or does it indicate something else? It looks like my other arm has the same muscle structure but is “intact”without the part of the deltoid slipping down.
Melvin
Hi Dr Howard,
3 months ago I’ve had a bad landing on an outstretched arm playing ultimate frisbee. MRI has shown that I have a 1.2cm by 1.8cm wide full thickness supraspinatus tear.
The orthopedic has recommended surgery as expected. However, physiotherapy seems to be working and I seem to be having almost a full range of motion right now. I have a few questions I’d like to ask to make a more informed decision on whether to undergo the surgery:
1. The supraspinatus tear does not seem to be affecting my movement much. If I were to continue my sport without surgery, what would the implications be since my supraspinatus is already torn anyway?
2. I am 24 now. Will a surgery bring about any problems like osteoarthritis at old age?
3. I am actually able to get by my daily routine with my injured shoulder (without sports). So does strengthening other muscles actually compensate and “replace” the functions of the supraspinatus? I’ve read that the supraspinatus allows for the first 15degrees of raising the arms laterally but I seem to be doing that fine with a torn supraspinatus?
In general Shoulder surgeons recommend surgery to repair acute traumatic tears in young patients…. The tears we tend to move more slowly on are chronic degenerative tears that occur in patients over 40.
Carl J.
Hi Dr. Luks,
thanks for the great website. I have truly learnt a lot about sports injuries.
I`m 41 and I`ve been doing some weights and climbing and cross country skiing at quite high level. I was diagnosed full thickness, 10mm wide tear of the supraspinatus tendon (medium and back parts) all other muscles and tendons are ok. No ROM restrictions, very little strenght loss, little pain too. Generally, my PT who specialises in climbing injuries says I will be able to get back to the same level of activity under the condition of lots of rotator cuff and shoulder stability exercises. My Ortho says I may be ok for some time but sooner or later it will be completely torn and if I want it to be really fixed I will need surgery.
1. Who is right: PT or Ortho?
2. Would you recommend surgery in my case?
many thanks
Carl
Sadly no one can answer that question reliably. These small degenerative tears are common. Most do not need immediate treatment. In active overhead athletes there is a risk that the tear can become larger over time. We really can not accurately quantify that risk. Some studies show that it might take years to become larger. Further injuries or falls of course can worsen the tear more abruptly. NO harm in waiting an re-imaging (MRI or Ultrasound) in a few months to be sure the tear is not becoming larger.
Rachel N
I had an injury over a year ago where I lost my footing going down some stairs and landed on my right side very HARD! I didn’t land right on my shoulder, but pretty sure I landed on my right arm. It was a very hard fall. I’ve gone to 2 orthopedic Doctors who both examined X-rays and a MRI I had done and both confirmed I had a moderate wide rotator cuff tear on my right shoulder and would need surgery, especially because I am in alot of pain and regular OTC pain med and physical therapy have not helped. My question is: I don’t just have pain right on the rotator cuff area, but also on my upper trapezius muscle, neck, and now headaches. Basically, the pain moves all around the upper right quadrant of my back and shoulder areas. My Ortho Dr said it’s because the areas I’m feeling pain is compensating for the rotator cuff tear itself. Is that a possibility?
Thanks,
-Rachel
Hard to say Rachel… sorry.
Barry A. Perlmutter
I am 59 years old and have had Surgery on both shoulders due to complete tears of my Rotator Cuff. The Surgeon told me there was a lot of Atrophy and a re tear is possible. A couple of years later I re tore both shoulders. Repair is not possible due to the lack of Tendon fiber and Atrophy. I’ve had Cortisone injections in my Right Shoulder which temporarily helped. Pain came back and The 3rd injection (spaced apart) didn’t help at all. The Left shoulder had 1 Cortisone shot that didn’t help either. I have full ROM and some weakness. My Dr. says I am to young for Replacement Surgery or any other repair. My pain is a 8 when I move it wrong or try to lift something. Any thoughts would be appreciated. Also I have Chronic Neck Pain.
howard2
There are various options that we offer patients with non-repairable cuff tears and severe pain. They range from a
1- superior capsular reconstruction
2- tendon transfer
3. reverse shoulder prosthesis
I think you should do some research and find a shoulder doc who can examine you and discuss your alternatives and what the pros and cons are for each approach.
Good Luck
John W.
Hi Dr. Luks and thanks for the informative website!
I am 36 year old male who had RC repair for a very large (tear edge at glenoid level) U-shaped isolated supraspinatus tear a year ago. Repair was successful, although a bit “technically challenging”. I had no specific traumatic event, and somewhat surprisingly no AROM limitations and very good strength in the shoulder before the surgery. No atrophy or fatty degeneration.
I have a similar condition now in the left shoulder, for which surgery is already scheduled. It’s not as severe, “only” a 2 cm tear, but considering how close to an irreparable state the right one had developed, I opted for surgery right away.
I have never smoked and I have no other medical conditions or medications that would be known to be a risk factor for these type of injuries. I have practiced weight lifting (and wish to continue with it once I recover), but on the other hand my actual line of work is a desk job and not demanding on the shoulders in any way.
Now what I’d like to ask you, is
1) have you encountered this kind of thing with a person of my, relatively young, age?
2) in your experience, what kind of longevity can I expect from the repairs? How likely would you say it is for me to have more RC tears in, say, the next 5-15 years?
Great question … This is why I am always talking about our lack of understanding of biology of rotator cuff tears. Why do they occur? Why do they occur in some people but not others — independent of activities. This is a complex topic. A theory known as the cable and crescent theory of rotator cuff tears was put forth many years ago. According to that theory the supraspinatus will develop tears due to loss of tension because the cable which transmits the forces in the rotator cuff excludes the supraspinatus insertion.
In other folks it simply may be your genetic make-up. Everyone’s tissues are different and have differing resiliency.
Unfortunately, because many tears occur due to degeneration — after a “successful repair” the recurrence rate is pretty high.
John W.
Short update:
Got back from left shoulder surgery. Tear was about half smaller than MRI suggested, cuff tissue was very good, and the surgeon said that a “very robust” fixation was achieved due to the good quality tissue. Acromion was also better than in the right shoulder, only a type 2 (right one was a type 3 with very narrow subacromial space).
In light of those facts, it kind of seems strange that the left one even tore in the first place. Hopefully there will be better information about these injuries and more efficient therapeutic options by the time I have my next tear. At my young age, I consider it almost a certainty that I will still experience more tears during my lifetime… hopefully not too soon, though.
Sylvia Williams
Dr. Luks, I am a 68 yr. old healthy, active woman. I have had aching arms and neck and have degenerative cervical issues. However, my shoulder hurt also but I was told it was most likely referred pain from the cervical neck issues. I insisted on an MRI of shoulder and sure enough, I have a full thickness tear. However, I am not really in THAT much pain….. sore and some pain if I “move my arm wrong”. But nothing I can’t live with. Most of my pain is related to the neck.
Orthopedic doc says I need to have rotator cuff surgery NOW because my window of opportunity is small at my age for a complete recovery. His argument is also that the tendon will retract making it impossible to repair it if I wait much longer.
Since I am not in a lot of pain and am not terribly limited in my activity due to pain, do you think this surgery is necessary? If I wait, will I get worse and miss that window of opportunity the ortho doc referred to? Thanks so much!
There truly is no such thing as a “window of opportunity” with degenerative rotator cuff tears. Truth is the consensus opinion on small full thickness tears is to treat them non-surgically. Even the Amer Academy of Orthopedic Surgeons recommends non-operative management of small degenerative full thickness rotator cuff tears. That being said,there are many different variables that go into the decision making tree for these tears (age, size of the tear, cause of the tear, what is causing your pain [may not be your tear], etc) . Many folks your age will have tears if we place them in an MRI machine… that doesn’t mean they all need surgery. I would consider a second and/or third opinion before making your final decision.
Jake
Can you have a large rotator cuff tear with little to no weakness but a good amount of pain?
yes… the entire supraspinatus (one of 4 rotator cuff muscles) can be torn and produce very little weakness.
Michael Brescia
Im 63 Year old male. Below is my last MRI of my left shoulder from this past February. I have the same problem with my right. However my right i have had 3 surgeries and none worked so needless to say AI am not jumping back into surgery. I am considering PRP or stem cell transplant. Is there any information you would have to help me decide. I currently go to pain management once a month. I will get injection about every other month. I go to PT 2 to 3 times per week. I am sure that is the only thing that keeps me going. Thank you
MRI-3T LEFT SHOULDER WITHOUT CONTRAST
HISTORY: M79.622 Left arm pain M25.512 Left shoulder pain M25.612 Left shoulder
stiffness M25.312 Left shoulder instability M75.02 Left frozen shoulder M75.42 Left
shoulder impingement syndrome M75.52 Left shoulder bursitis
TECHNIQUE: Left shoulder imaged on a 3.0 Tesla ultra high-field wide-bore MR scanner using
multiplanar multisequence technique.
COMPARISON: No prior studies are available for direct comparison at the time of this
interpretation.
FINDINGS:
Acromion and bursa: The acromion has a hooked configuration (type III). Mild degenerative
changes are present at the acromioclavicular joint. A moderate amount of fluid is present
in the subacromial/subdeltoid bursa.
Rotator cuff tendons: A complete full-thickness tear of the supraspinatus tendon is
present with torn fibers retracted approximately 4.0 cm. Infraspinatus tendinosis is
present with full-thickness tearing involving its most anterior aspect. Subscapularis
tendinosis is also present.
Biceps tendons: Tendinosis of the long head of the biceps tendon is present with low-grade
tearing at its intra-articular location.
Cartilage and labrum: Superficial cartilage loss is present in the glenohumeral joint.
Subchondral cyst formation is present in the inferior aspect of the glenoid. Degenerative
tearing of the posterior glenoid labrum is present. A small glenohumeral joint effusion is
present.
Bone marrow: Subchondral cyst formation is present in the greater tuberosity. The bone
marrow signal is overall age appropriate.
There is no evidence for lymphadenopathy in the visualized portions of the axilla. No
asymmetric muscle atrophy is present.
IMPRESSION:
Complete full-thickness tear of the supraspinatus tendon. Full-thickness tear involving
the anterior aspect of the infraspinatus tendon. M75.122
Subscapularis tendinosis. M67.814
Tendinosis of the long head of the biceps tendon with low-grade tearing. M75.22
Degeneration of the acromioclavicular and glenohumeral joints. M19.012
Nondisplaced tearing of the posterior glenoid labrum. M75.82
Glenohumeral joint effusion. M25.412
degernative rotator cuff tears are difficult to treat… the recurrence rate (developing a re-tear) is quite high.
PRP or stem cells will not heal the tear. They might decrease inflammation and pain… but the tear will not heal.
Sounds like PT is your friend right now… I would continue.
Jon Serper
Hi Dr Luks,
I am 51 years old and play competitive basketball and golf. In Feb I was diagnosed with impingement in the left shoulder. A few weeks later on a followup the doctor noticed some weakness during an empty can test and thought i should get an MRI. I never got the MRI but I went to PT and spent the next 5 months rehabbing my shoulder. Today my shoulder feels good and i have what aooears to be full strength back. Ive been playing basketball for two months and i am just now swinging a golf club at full speed/power – both with an occasional twinge like discomfort that is a small fraction of my old impingement pain and that always goes away quickly.
My concern is that my shoulder may have a tear and that because of the stress im putting on it that it could be sort of a ticking time bomb. Ive been cautious when i do feel that twinge and it just seems that things are stable. Do you recommend i go through tests or just manage my shoulder based on feel as i have been?
Regina B
I’m a 54 y/o active woman. MRI on right should revealed 1) Complete tear of the supraspinatus tendon with 3 cm medial retraction of the tendon on a background of tendinosis. Moderate grade intrasubstance tear of the anterior fibers of the infraspinatus tendon. Low grade intrasubstance tear of the upper fibers of the subscapularis tendon. 2) Moderate tendinosis of the intra-articular portion of the long head of the biceps tendon. 3) Tear of the posterosuperior and superior labrum. 4) Small joint effusion communicating with the subacromial sub deltoid bursa.
Would you recommend surgery knowing I am in constant pain & cannot sleep? Which procedure would you recommend? Would arthroscopy be an option?
Any advise you could give me would be most appreciated. Thank you for doing this post. Reading your responses has been extremely helpful.
That will be a difficult tear to fix… and it will likely re-tear after surgery. For degenerative rotator cuff tears — the most appropriate initial treatment appears to be PT/Injections for a while to see how you do.
Debbie
My rotator cuff tissue is of good quality according to my Ortho surgeon. Dr. Luks do you recommend that I get this recurrent tear fixed or should I just leave it alone? I will be seeing my Ortho surgeon next week to discuss my options.
Thanks.
Debbie
Hi Dr. Luks,
I had a rotator cuff repair surgery for a massive rotator cuff tear back in Jan. 2014 which I sustained from a fall in Dec. 2013. The surgery went well and my rehab was good as I gained back most of my ROM and strength, however my External Rotation ROM and strength didn’t really all come back. But I was able to return to playing tennis and softball without much problems. At the beginning of June 2016 I began to notice weakness in my arm when I tried to reach overhead, was harder to steer the wheel in circles, my shoulder felt tight when reaching in front. I went to see my Ortho doctor and he ordered an MRI.
My MRI results are a recurrent tear of the surgically repaired posterior supra supraspinatus and infraspinatus tendons with 23 mm of medial retraction and 23 mm anterior to posterior gap. Mild decrease in muscle bulk.
I don’t recall doing anything to cause the recurrent tear. I don’t have much pain just the weakness. I can function normally except for the weakness in doing somethings with my shoulder or arm in certain positions. I had no previous shoulder problems before my initial injury. My rotator cuff tissue is good quality.
My Ortho doctor doesn’t really know what could have caused the tear. He feels that the retear either is due to a recent aggravation of my condition or there is a possibility that my posterior rotator cuff never fully healed following the initial surgery. My doctor suggests to try strengthening me with physical therapy and If I do regain my strength and I’m asymptomatic, then I won’t need further surgery. But If I continue to experience weakness, I’ll most likely need to undergo a re-repair of my posterior rotator cuff. Well, I have been to physical therapy for 4 weeks, but I haven’t seen too much improvement yet. My physical therapist says that it is highly unlikely that I will be able to strengthen much of the rotator cuff since it is a full thickness tear, thus physical therapy will not help me in this case.
I saw another Ortho doctor for a second opinion and he said that I will eventually need revision surgery to repair it.
What are your thoughts? Can physical therapy help strengthen the rotator cuff so that I won’t need to have revision surgery? How many weeks of PT before deciding that it is not working and thus will need to have surgery? Should I have surgery to re-repair the recurrent tear if I want to continue to be playing tennis and softball and is there a certain time frame that it should be done by for better outcome? Is 23 mm retraction pretty far? If if I don’t have the surgery now or at all, can the tears get larger and muscle atrophy and fatty infiltration occur and tendons retract further away in the future thus making the revision surgery irreparable?
Thanks!
Unfortunately recurrent tears are very common in large tears. Up to 50% or more will fail. Revision surgery is far less effective than the first attempt. Most experienced shoulder docs will consider using a graft or augmentation during a revision surgery… but the research is not clear as to the benefits of that. Difficult decision making for the patient and the surgeon. Sadly, this is the nature of rotator cuff tears and why I refer to it as rotator cuff disease… because the tendons truly start to wear out… and we have not found a definitive way of reversing that degeneration. So most tears occur or reoccur because of a biological (tendon degeneration) problem… not necessarily because of a failed mechanical issue or poor repair.
RPP
I have a full thickness tear and am still pitching. I need to do lots of stretching and rubber band strengthening but after slowing warming up, i’m able to still pitch competitive baseball. How long do you think i’ll be able to get away with it before the tear worsens and stops functioning?
unfortunately no one can give you that answer. For some it may be years, for others it will be less time. Good luck!
Scott
Dr a few days ago while on vacation. I fell and landed on my right shoulder. Didn’t feel much pain for about 48 hours. I went to the doctor and got x-rays. Which showed no fracture break or dislocation. After icing and ibuprofen I seem to have decreased pain and better mobility. However when getting out of bed and few times. I have used the arm to push up. And feel something pop and it’s extremely painful. Once my arm is straightened again. It seems to pop back and the pain is gone. At what point should I be concerned? The injury is recent . And the doctor seems to think time will fix it
Tough to say what is happening without examining you. In some cases the biceps may be causing this… in others in can be the rotator cuff, etc. Hopefully your doctor, or a second opinion can figure it out.
Janice
Hi…thoughts please. Fell and suffered full tear of rotator cuff, herniated cervical disks, concussion etc After 6 mos of PT, have good ROM and arm is stronger, however pain increases in shoulder and neck when using arm for gardening, chores etc. Suffered a partial bicep tear while vacuuming recently.. First time I saw surgeon he recommended surgery as he felt I was too active and young ? to have a full tear. Not sure what to do ….good ROM, good strength but suffer bouts of pain when really using arm.
Tim South
Hi Dr. Luks, I lift weights at a competitive level, I am 55. I had a fall on concrete about 6 days ago. I tore my other rotator cuff 30 years ago, had it operated on and it has been problem free after 30 years of weights. Initially I didn’t think I landed too hard on my other shoulder as I tried abit of a roll to save my arm. The next day I couldn’t lift my arm shoulder height. I have had a x ray and an Ultrasound 3 days later but haven’t met with the doctor to review the results. The first three days I was convinced I was heading back for a matching rotator cuff surgery. However, on day six there was some improvement as it seems to be posibly calming down. I failed the 3 tests for rotator cuff tear three days ago. Is there any chance that I haven’t torn it and it will heal over time? How long do you prolong surgery? I know the diagnostics are the definitive answer I was just wondering the percentage who sho improvement in 6 days my not require surgery.
Thanks
Mary Nedry
I started having arm pain about 2 years ago (night pain etc) and my Dr. thought it was something related to my neck or tendinitis so it was awhile before I was properly diagnosed. After seeing an ortho Dr. he did an X-ray and ultra sound of my right shoulder and said I have a complete tear of the rotator cuff. He couldn’t even see any of the cuff, so wasn’t sure if he would be able to fix it. Also, it had been about 9 months since the symptoms first started. I decided against having surgery and so far, it has been ok. Some pain, but the worst pain (earlier) seems to have subsided. Today I noticed a hard bump almost on the top of my shoulder, about 3 inches in. It doesn’t hurt and doesn’t really move around. Could this be something related to the rotator cuff problem? Thank you!
An ultrasound is useful to diagnose rotator cuff tears, but is not nearly as accurate as MRI in determining if a tear is repairable.
Cysts or a mass on top of the shoulder can be seen in people with large rotator cuff tears, but if the mass persists, having another ultrasound or an MRI to confirm it is a cyst (filled) with fluid would be useful.
keith alwexander
hi I have a 10mm full thickness tear at the point of insertion of the supraspinatus tendon surgeon says must be surgically repaired as only option do you have an opinion???? pain levels come and go
Not what the research says …. many variables are considered when determining which tears should be repaired. Consider second and third opinions.
Frank
Hi Doctor. I have severe pain in my right shoulder. It started out very mild and 6 weeks later it’s almost intolerable. I did not injure it. It feels like it’s emanating from the deep center of my shoulder. I need to use my left arm to lift my right. I’m 59. What do you think? Frank
Very common complaint Frank … if you are concerned you should see a shoulder doc. At our age the most common cause of this pain in the rotator cuff. But until you have an Xray and or MRI (if necessary) that is just a diagnostic probability and not a diagnostic certainty.
C.K.
I fell on March 17th and hurt my shoulder. I could not lift my arm. I am 58.
From March until last week, because of the hospital computer tag system”OT?PT” I received OT instead of PT with massage and patches. My range is worse than it was when Is started in March.
On Monday I asked for an MRI, which I had MOnday night. The result form the MRI is a “High Grade partial thickness tearing of the rotator cuff” I received a cortisone shot this morning.
Is it too late(now about three months) to try the PT? The orthopedist says I need to see the surgeon and I have an appointment for July 5.
Does it depend on how big the tear is?
Thank you!
definitely not too late… also.. no indication for surgery either based on your MRI.
Joe Nitro
Dr. Luks,
I have read the comments on your page and would like clarification on a few things. I read that a full- thickness tear is when the tendon is torn off the bone. If that is the case, how can the tear get bigger if it is a total separation from the bone? When saying the tear gets bigger is that referring to the retraction of the tendon increasing in size? I am 51 and lift moderate weights. Injury in Feb 2016. An MRI in May 2016 revealed a full-thickness tear of the supraspinatus tendon and it is retracted medially for around 2cm. There is some atrophy to the muscle. My Dr stated she would reattach tendon to the bone. From looking at the anatomy of a shoulder, it looks like the supraspinatus muscle is rather small and it appears that the other 3 muscles play a more significant role in the shoulder. In your opinion would the stability or strength of the shoulder diminish over time if I did not have the surgery. The strength in my shoulder right now is still above average.
Great question… there are 4 tendons that compose the rotator cuff. You can have a full thickness tear of only one small part of one tendon… or you could tear all 4 tendons. The words full thickness tear only describes the depth of the tear in a certain region. You have only torn one of the 4 rotator cuff tendons.
Alyssa
Hi Dr. Luks,
I’m a 16 year old female. I play softball (pitcher and 3rd base). I’m also a lacrosse goalie. Over the last couple years I have gradually experimeced more pain when playing catch (in softball). I have recently experienced rock tight muscles all over my back, and especially around my right shoulder/scapula. As these tight muscles developed, I also experienced popping noises when moving my arm throughout my daily routines and when playing sports (softball and lacrosse). Is it normal for that to be popping? What do you think caused the sudden oncoming of the tight muscles and constant popping? I have, for the most part, been in quite discomfort (back/right shoulder) no matter what I tried to do. Recently, my pain has dramatically increased and has shifted away from the scapula and more towards my actual should (possibly rotator cuff muscles?). Since this rapid increase in pain, in worry that something is wrong, and fear for my future of wanting to be a college athlete. The past two nights I have experienced extreme sudden pain (muscle spasms?) at night (yesterday it happened around 5:30pm and tonight it happened about 9:40pm). When the sudden pain comes on, my arm basically becomes immobile, but then after a nights sleep, still hurts, but isn’t quite as acute. When it happens, I’ve been taking pain reliever and icing it to cope with the pain. The pain is on the posterior and distal side of my shoulder. Is there anything you know of that could be causing me all of this trouble? Am I self-treating this right? Ima Los supposed to play in a softball tournament this weekend and have lacrosse clincs on Tuesday and Wednesday. I have bought a shoulder brace to wear when playing softball. It seemed to help stabilize it some. Should I keep playing? I don’t want to ruin my shoulder / my chances of being a college athlete (for lacrosse), but I love to play softball and want to enjoy it while I can with my team throughout my remaining high school years. Could I have a rotator cuff injury or is it something else?
Thank you for your time! Loved your informational article!
Alyssa
HI ALyssa … At your age you really should think about seeing an orthopedist who specializes in shoulders.
Cathy Duggan
Hi Dr. Luks,
This is a fascinating page! I am an active 61 year old female. I go to weight training classes and walk daily. My shoulders have not been “right” for a long time. I kept telling the trainer that they feel like they are going to break off with certain exercises. After two years, he told me to go to the doctor and find out what is going on or he could not let me do the shoulder exercises anymore. I had an MRI on both shoulders, my right is somewhat worse than the left. The Impression on right was: Complete rotator cuff tear involving the supraspinatus tendon, Complete rupture of the tendon of the long head of the biceps, small tear located posteriorly in the glenoid labrum and shoulder joint effusion. The left shoulder had the first two symptoms and the third says simply small effusions. He said to fix it he would have to do a reverse total shoulder replacement on the right and possibly the same with the left. When I asked him what he would recommend, he said I would know when and if I want the surgery – it was totally up to me. He has no way of knowing if it will get worse and I could get physical therapy and shots to see if that would help. The shot did not help at all – the physical therapy kills me – but I am doing it daily and still going to my weight training classes. Do you agree that putting off this surgery will not automatically result in my shoulders getting worse? If I can stand the pain and live with it I can put it off forever. The doctor said he was amazed that I have as much motion as I have with my condition – the physical therapist says the same. Thank you in advance – I have learned alot in reading your answers to others questions.
Go as long as you can go before considering a reverse… that is a risky procedure with a high complication rate. I would probably have a second opinion doc take a look at you.
Cathy Duggan
Thank you so much for answering! In looking at my MRI results – do you think a “regular” shoulder replacement would be possible instead of the reverse?
Cathy Duggan
OR – can this condition be fixed with just rotator cuff surgery (reattaching it)? My doctor said there is too much “stuff” where it used to connect and he could not reattach.
Adam
Dr. Lukes,
I am a 29 year old male with an extremely active lifestyle. I love to lift weights, swim, run, crossfit, basketball, you name it. I had a huge shoulder injury playing flag football and had it surgical repaired early October 2015 (almost 8 month ago). I had a small tear in supraspinatus, large tear in subscapularis, with a SLAP lesion and biceps tenodesis. The pain was excruciating for months after surgery. Apprxomatly 5-6 months after surgery I had to move some heavy furniture for two days (Big Mistake). After the second day of heavy lifting my shoulder was very sore for about a week. I went to see the doctor who ordered an MRI which came up negative. Cortisone injection and out the door. The problem is that I am still have some significant pain in front of my shoulder near the subscap with pretty much any movements. Odd thing is that I don’t have any pain with resisted IR or when I try to put my hand behind my back. I have a very sharp, intense, and burning pain in a distinct location directly in front of my shoulder with resisted ER or abduction. The MRI was negative but I feel like I should not be in nearly this much pain this far out. Now I am not sure what I should do. Am I overreacting or should I consider getting a second opinion. Maybe an MRI with contrast or ultrasound would be appropriate? Any advice would be very much appreciated. Thanks so much!!!
HI Adam…
Getting a second opinion is rarely a bad idea.
Selective injections under US might be able to tell you where you pain in coming from. Doesn’t sound like subspap.
Kimberly
I stumbled on this page when I searched for rotator symptoms. :) I cannot believe I’ve read most of these comments! You are amazing! Thank you for providing this space and your contribution. Its evident I need to go back to my shoulder doc. Initially, he did an x-ray BC I developed terrible pain in just the shoulder for an unknown reason, and could barely lift my arm. However, it improved some on its own after a week, but then my clavicle started hurting, too. Doc said I had a frozen shoulder and I did therapy for a few months, which helped but still had some minor pain I could handle. BTW, nothing really showed on the x-ray except for a little arthritis that Doc said was insignificant. Last week I overworked (gardening) and now my shoulder hurts again as does that side of my neck muscles, clavicle and breast muscles and a little back wing…same side. I know something in my shoulder is triggering this…probably more than one thing. I’m going to request an MRI because after reading all these posts, it’s clear xrays seem like a waste of time and money. Why do doctors even bother doing them? Why not just do the MRI from the get go?
Thank you for the kind comments :- )
X-rays are an important part of the treatment process. If they are normal that takes many potential problems off the table. MRIs are only needed when people have persistent pain despite adequate non-surgical treatments.
Tracey
Not sure if this is still being monitored but thought I would give it a try. I had a fall last Oct, 2015 going through a doorway. To try to break my fall, I grabbed the door entryway but fell forward stretching my left arm backwards. I was sure it was broken as I couldn’t move it without severe pain but decided to immobilize and ice. Eventually it got better but has never completely healed and I still have pain lifting it up or backwards. Sleeping is difficult still. My question is this. The pain is not in my shoulder but just below the deltoid. Could this be a symptom of rotator cuff tear given the location of the pain or something else?
Thank you
Yes Tracey … that is a common location for rotator cuff related pain. So, x-rays and a good exam are a good idea if your pain persists.
Mary
Hi. I was in a bad car accident about 1 month ago. Can’t have an MRI since I have a pacemaker. I had an injection and still have a lot of pain. PT is causing so much pain. MD can’t tell how bad the tear is. How long do they wait. The pain is so bad.
Many radiologists can perform an ultrasound to assess the rotator cuff.
Many radiologists can perform an ultrasound to assess the rotator cuff.
Jayzlee
Hi, I am a 16 year old female currently in volleyball and cheerleading. During stunting last basketball season my shoulder felt as if something had tore. I didn’t think much of it, since the pain was minor, but it seems to catch quite often. It also seems settle differently when relaxed; it’s fairly uncomfortable. This has been going on for quite some time now and seems to be getting worse the more I use it. I don’t exactly want to be out of sports next year, but I don’t want my volleyball career gone either. May I please have your opinion?
At your age, injuries to the labrum are more common than rotator cuff tears. I would see a sports medicine specialist so you can be examined.
Joseph Dharamsy
Dear Dr Luks, I am 24 yr old male with an insisious right shoulder pain and injury. MRI showed an almost complete tear of the infraspinatus muscle from the tendon (which is still attached to the bone). I am told it is an unusual injury or tear. Surgical options are not good. I take pain meds and would like to play sports again. Please advise. Thank you
Joseph MoDee
It is an unusual injury, but not one that is impossible to fix. Many of us have tackled these before. IN general, it is best to fix these sooner rather than later before the muscle retracts.
Sean
Hi dr Luks. Can a full thickness tear in the suprinatus about .9cm long heal by itself?
e john mcgarvey
question please:
my MRI shows a full tear supraspinatus tendon, can i heal with out surgery and if so whats the process?
Frank
Hi Dr. A couple weeks ago I was standing on a log about 20 inches off the ground. It kicked out and I grabbed a swing set with my right hand. I let go when I thought I may be tearing something and hit the ground.
I am 55 years old and active. I play softball and before this I can throw the ball like I did when I was 20. It’s been 2 weeks and It hurts to throw hard. I only tried once. I have full motion and there is not much pain when moving my arm in all directions. I do hear a pop if I raise my elbow and put my hand behind my head. Does this sound like something that will heal to the point I get my ability to throw hard?
Thanks in advance for any advise.
Frank
James Chen
Hi Dr. Luks,
I am turning 60 this year, and pretty health in general. I play recreation volleyball regularly. I felt right shoulder pain in early January this year after a play. I had a MRI test last week after the pain occurred over three months ago. The report says I have a full-thickness full-width tear of the supraspinatus tendon that extends into the infraspinatus tendon measuring 2.3cm in anteroposterior dimension. Currently, the pain I have is bearable, and I can move my arm all around, though sometimes feel weak. I read some comments online that say full-thickness tear never heals by itself. In my case, do I need to do surgical repair for the tear. If I don’t what could be the consequence in a long run? Thank you.
Correct James .. a tear that size will not heal itself. The more important consideration is which tears become larger or progress if observed. We often observe and do not operate on small degenerative tears. But… Once a tear becomes as large as yours the chance of it becoming larger increases. IF a tear becomes larger the arm becomes weaker and you will notice a loss of endurance.
Eileen
My Dr has been treating me with Rotor cuff tendinitis since Oct 2015.. It is now the end of Feb 2016..The pain is unbearable, I cannot wash my hair, fasten a bra, drive my car, the pain continues to get worse and I have been on flexeral, naproxen and tremedal for pain since Oct ..Sleep is impossible as I just cannot get comfortable in bed to sleep..I have used a sling since Oct only removing it to drive, shower, do light housework..I had x rays which showed nothing wrong, waiting now to see a Orthopedic Surgeon..I went today to see a Chiropractor who made it clear there is nothing he can do with that arm and it’s an awful mess..He believes my rotor cuff is torn and that it is not tendinitis..At first I had steady pain on the top of the shoulder and down to my elbow..Now the pain is shooting down my forearm..I cannot raise my arm, place my arm behind me..How do I get my Dr to actually do a MRI..The Chiropractor I seen today was disgusted that I have had to live with this pain since Oct and still only now getting in to see a Orthopedic Surgeon .Quality of life is horrible because with the pain I have no desire to do anything and the lack of sleep has left me physically drained, huge black bags under my eyes, can’t drive my car or even go for a walk because even with my arm in a sling I just can’t handle any more pain .Also concerned about possibly having surgery and wondering how long the recovery will be before I can actually return to work, also wondering if there is anything they can do to stop the pain and get the arm moving without the surgery..I am single and really need to work . I am the one that decided to see a Chiropractor on my own.. I actually have 2 injuries as I am dealing with post concussion syndrome as I fell Christmas Eve knocking myself out and now suffer with neck pain and restricted neck movements..I decided to see a Chiropractor to see if he could address both issues but as I stated he already made it clear there is nothing he can do with my arm and he doubts very much that it is tendinitis and believes it is a torn rotor cuff
Chloe
Hi this is Chloe,’
Yesterday I fell on my shoulder and it limits my motion without pain such as reaching up or behind. I was wondering if this could be a rotator cuff sprain or tear. Is it possible to know without an MRI scan?
Thanks You!
Decreased motion or the onset of weakness in the shoulder following a fall can be due to a rotator cuff injury
Deb
Should a surgeon recommend surgery for the following MRI findings? Mine is, and I’d like to understand if I should get a second opinion.
TECHNIQUE: T1, proton, and T2-weighted imaging was performed.
FINDINGS: There is a partial undersurface tear and the anterior supraspinatus tendon insertion.
There is bursal surface thinning and fluid in the adjacent subdeltoid bursa. An occult non-
retracted full-thickness tear is suspected on series 3 images 19-21. The infraspinatus,
subscapularis, and teres minor tendons are normal. The rotator cuff muscles are normal.
The glenohumeral articular cartilage is normal. There is no labral tear. The biceps tendon is
normal.
There is acromioclavicular arthrosis with small inferior spurs causing moderate outlet narrowing.
There is fluid in the subacromial bursa.
IMPRESSION: There is at least a partial undersurface tear of the anterior insertion of the
supraspinatus tendon with bursal surface thinning. A full-thickness tear is suspected.
Fluid in the subdeltoid and subacromial bursa.
Acromioclavicular arthrosis with moderate outlet narrowing.
Thank you –
The American Academy of Ortho Surgeons recommendations would say no, current literature would also say no. This is degenerative rotator cuff, it is a very common source of pain. Most surgeons would treat this with physical therapy, and perhaps an injection to minimize your bursitis. Surgery is an option for those whose pain fails to improve with non-surgical treatment and surgery is an option if, over years, the degeneration worsens and becomes a full tear.
Deb
I can’t thank you enough. I’m 56, had mild to moderate pain for a few months (not caused by a specific injury) with certain movements and some at night. No offer of PT/Shots, was told only surgery would fix it (open mini rotator cuff surgery – 6 weeks in a sling and many months of post surgery PT). This seemed like overkill and frankly frightening to undertake. We live in rural Maine and don’t have a large number of specialists to pick from.
With Gratitude,
Deb
Katya
Hi Dr. Luks. I’m from Canada and live in a province where ortho surgeons take upwards of 13 months to see, and another year until surgery. I have been told by my MD that my right shoulder rotator cuff has 2 “significant” tears (more than .8 cm) and my left has one .6 cm tear. My right shoulder, when I cross my arm across my body and pull (such as a belt, or putting deodorant under the opposite shoulder, causes a ‘clunk’, accompanied by an abundance of pain, followed by at least one day of moderate pain right in the middle of my bicep plus poor ROM. In order to relieve the acute and sharp pain, I must, with my left arm, passively lift my right arm to behind my ear and gently pull and hold it there for approximately 8-10 seconds. I then can not lower my right arm on its own steam…my left arm has to do that. PT will not work according to my MD, and as of about a week ago, I got a cortisone shot that has had seemingly no effect. Will waiting another couple of years of this ‘clunking’ cause my shoulder to be irreparable surgically once I get to OR?? I am a gymnastics coach, and I instruct and ride horses. My whole life has to change if I can’t get my shoulder pain/functionality under control.
both of those tears are actually pretty small. Most people with small tears due to degeneration and not an acute traumatic episode are managed with physical therapy and they do get better. The response rate to PT is very high… but it’s not 100%. I would certainly consider trying it.
Dawn
Hello I’m dawn I had MRI which shows rotator cuff tear I had cortisone shot and physical therapy now I’m feeling pain in neck chest down arm into all 4fingers pain worse at night keeps me up at night its hard to hold cup or open jars e even typing this.its seems to be worse very fatigue
That’s not coming from your rotator cuff. Someone should evaluate your neck.
David
Hi, Dr Luks.
(Updated version to include pain during the day)
I was playing basketball for about 2.5-3 hours a week ago Sat and fell down hard one time and played hard (physical basketball). My shoulder felt fine. Then I did about 12-14 pull ups and went home. Maybe 30 minutes to an hour or so later I felt some significant pain in the shoulder, and I couldn’t lift my arm up (like to take my shirt off) without hurting. It hurt for two to three nights when I slept.l and during the day as well when I moved it.
The pain has gradually diminished each day (after 2-3 days), and my arm’s range of motion has gradually returned. It still hurts a tiny bit when I lift it super high–but the pain and range of motion slowly improves each day.
Is this probably a case of inflammation? Or something else perhaps? If it was partially torn, would the pain go away like that? I know I would need to get it looked at to be perfectly safe, but what does it probably sound like It is? Thank you for your time.
I can’t say for sure without examining you. It is your rotator cuff that’s bothering you. But it could be a bruise, tendinosis, etc … If it doesn’t improve see a shoulder doc.
Good Luck
David
Thank you, Sir! Your posts are very much appreciated. Keep up the good work on here.
Dave Smith
Can full thickness tear of the suprasinatus tendon from acute injury, which apparently retracted to the superior margin of the glenoid—according to MRI report I just got–be surgically repaired typically? This just occurred a week ago but I haven’t consulted with the orthopedist yet. Thanks.
It might not be acute … it might have been there and worsened a bit when injured. Sometimes they are repairable, sometimes they aren’t
Laura
I tore my rotator cuff last year – actually a full year ago. In March, I was thought to have a frozen shoulder. I went for an xray, visited a chiropractor, had acupuncture, and eventually was given tylenol 3 to be able to sleep at night – agony! I wasn’t able to lift anything, drove with one hand, dressed with one arm, and was unable to keep up in my fitness classes, and yoga. I am 47 years old, and after about 5 months, an ultrasound determined I had a full thickness tear of the rotator cuff. I was advised that surgery would be my best long-term bet, which I put off for a couple of months, and instead did very light physio with bands and dangling arm swings. I also stopped any heavy lifting whatsoever. By November, I was nearly back to normal, and today, I am fully able to perform as usual, and have no lasting effects. I’m glad I didn’t get surgery, and I am extra-glad that I feel like a whole person again! The human body really does have the power to heal itself!
No question … we can recover from small tears… Just remember, sometimes these tears can become larger over the next 2-4 years… so stay in touch with your doctor.
Dani Frederick
Hi Doctor! This site is so wonderful and very informative I absolutely appreciate it. I started about eight weeks ago with severe rhomboid pain on my left side. It acted up more so when sitting at my desk at work or even while driving. I would use a lacrosse ball to help roll it out which would ease the pressure tremendously but after a few weeks I began to notice tingling and slight pain in my shoulder. After the primary care doctor ordered an MRI was found that I have a small tear in the rotator cuff. I still have full range of motion, no pain other then a bit of an ache when actually moving the arm but more so when standing still. So when I’m at my desk or watching TV or at night. Sleeping is the worst, I wake up with excruciating pain and have to take a pain pill. 1 Ortho recommended surgery right away – total turn off for me. I am going for a second opinion. Recently just started physical therapy and the hardest part is I am physical fitness instructor so the use of my shoulder is a must. I don’t want to run into surgery but do you see patients who have severe pain recover fully without surgery? I am still teaching at the gym but have removed all weights from shoulder workouts, taken out planks and push-ups etc. it’s just this pain!!! More so at night can be unbearable. For it being “a super small tear” it hurts so bad! Also how long can recovery via PT take on average? Thank you so much! Oh how I wish your office was closer!!
If your pain truly is in the rhomboid region then it is not because of the rotator cuff tear. The rotator cuff will cause pain on the side of the arm, or on the top or front of the shoulder. Rhomboid pain is usually due to a strain, could be referred from the neck ,etc. Get as many opinions as necessary — until you are comfortable with the advice.
bob becher
mri showed full thickness rotator cuff tear at the insertion with approximately 1-1.5 cm medial retraction. the tear involves the anterior 2/3 to 3/4 of the tendon with some of the posterior tendon fibers remaining attached to the greater tuberosity. no rotator cuff muscle edema, fatty infiltration or atrophy. is it possible that this tear could be longstanding although shoulder nonsymptomatic until recently.
absolutely possible
Zach
I am a college pitcher who had labrum surgery last year. I did rehab and everything exactly as my surgeon and therapist told me. Now when I throw I have pain in what looks to me like my teres. Could this in anyway be linked to a rotator cuff injury?
It could be your rotator cuff … hard to say without an exam.
Guilie
Hi Dr. Howard,
I am a healthy 26 year old male, body weight 150 lbs. I regularly lift weights for almost 3 years now and three days ago I was doing standing dumbbell press with a 30 lb weight in each hand and felt a pain in my left shoulder. The following days I haven’t been to the gym and I with some pain, a mild one. I can raise and move my shoulder without problems but sometimes it hurts. I’ve been taking 600 mg of ibuprofen twice a day for the pain, nothing else.
Do you I might have torn my cuff? How much time should I rest before going back to the gym?
Thank you!!
it is very unlikely at your age.
Taylor
hello i and 14 and i play football i was running and dove for a pass and landed on it and now i cant move my arm above my head it hurts to do anything with it. for treatment we used icy hot to help any ideas\
Because of your age, you should see an Orthopedist to have your shoulder evaluated.
Lisa
Dr. Luks, I had some questions regarding an injury I suffered earlier this year and treatment plan. I’m a 52 yo female, in fairly good health, and in March fell hard on the pavement with my arm outstretched. I dislocated my shoulder, breaking the humeral head. In the ER, it was over 8 hrs before the dislocation was reduced, and I ended up in a sling for over a month before starting PT. By June, I wasn’t improving as much as my Dr. expected (couldn’t lift my arm front/side to shoulder height or reach across to my opposite shoulder or behind my back). My Dr. (specializing in ortho trauma) performed a manipulation under anesthetic. I made good progress with passive ROM and in some active motion but was struggling to make strength gains. I was on pain meds before/after PT (3x wk) and nightly to sleep.
Because of the strength and pain issues combined with active motion restriction, I was sent for an MRI. The MRI came back showing a full through 2.5cm tear to the supraspinatus tendon, no visible muscle atrophy or end retraction. Both the Dr. and the surgeon he referred me to were surprised. At my first appointment and MRI review with the surgeon, he gave me two vials of cortisone and prescribed another 4 wks of PT to increase ROM. I have to say that the cortisone shot was a miracle! I have made great strides in active ROM (flexion and external rotation) and my pain has been greatly relieved. I’m still rather limited in my abduction (both passive and active) and really limited in my internal rotation (almost no gain at all).
I just saw my surgeon for the first 4wk post PT eval and he has indicated that I may be “good enough” and not need surgery to fix the tear. His reasoning was that I’d be stiff from surgery, recovery would be long – up to a year – and I may not come back to 100% of what I have already gained back. The plan when I left the office was another 4 wks of PT 2x wk. to see if I can maintain my flexion/external rotation numbers and make gains in strength, internal rotation and reaching behind the back. I noticed that the report to PT now says “partial tear”. I was told I could come back for another cortisone shot, if needed for swelling and pain.
1) The cortisone worked great, but I thought that too much cortisone was not a good thing for the shoulder structure (I’m 52, not 75). Is it something I can have as needed on an indefinite basis without damage? 2) I don’t understand diagnosis going from a full 2.5cm supraspinatus tear to a partial tear. Since it only is involving the one tendon, rather than multiple, could that be why it’s considered a partial tear?
I’m thinking of getting a 2nd opinion, but don’t know if “good enough” is a good or acceptable outcome in this situation. It almost sounded like I was being discouraged from pursuing a surgical fix. Thanks for reading, and thank you for any direction you can give.
A 2.5 cm tear is a good sized tear … and it will likely get bigger over time.
I would pursue a second opinion for an exam and further discussion of your options.
adam
I’m not over 50 is that all you can tell me
adam
Howard I do masonry for a living I recently lifted a bucket of grout about half full over a wall with both arms out in front of me and my right shoulder popped out and right back in. I waited three days and then my boss sent me to the doctors they ran some test where they held my arm up and then let go they did this until I got closer to the front of my body that’s when I couldn’t hold I up because of the pain. he is sending me to physical therapy and said I have a 50 50 shot it will heal on it’s own the injury is only a week old and the pain is different everyday and not as sever as when I went to the doctor I have more movement but it still hurts if I move it across my body or straight out in front of me. even though the pain has lessoned could it still be a tear that needs fixed? it has also started hurting if I fall asleep with my arm above my head or to the side I am trying to understand what I should be feeling because it changes everyday. Thanks for reading
Dislocations in people over 50 generally require imaging to assess the integrity of the rotator cuff.
Julie
Just thought I’d leave my own experience with a rotator cuff tear, in case someone else has it too.
I fell down the stairs and have my arm wrenched between two rails. Thought I had walked away with only a tiny fracture in my forearm.
Almost a year later, I had unexplained horrible aching pain from my shoulder to my elbow that would last for several sleepless days, then disappear for a week or two.
Turns out, I had torn my rotator cuff during the fall but it healed improperly on its own. I had no idea how limited my range of motion had become and it had never occurred to me.
Now doing rehab work with a chiropractor to regain full motion. It’s going really well, no surgery or injections. It’s not painless and involves twice a week visits for months, but I’m thrilled to have sleep and strength back in that arm!
Alison
Hi, Dr. Luks-
Thank you for your website. As with everyone else, I would very much appreciate your opinion. Had an acute injury weight lifting a year ago, but did basic home care (ice, rest, etc.) and it got better. But it started hurting in November again, so I began taking ibuprofen. Unfortunately, that lead to my getting ulcers in various GI areas, so I was told I couldn’t take NSAIDs. By March, I really hurt, so went to a doc (occ health, not ortho) who sent me to PT. Did that for a few weeks, no improvement. Did a cortisone injection. Insurance denied MRI saying I had to do more PT. Did more PT, no improvement. Finally got MRI and it said I had a “small” tear in the supraspinatus and a “moderate” tear in subscapularis. Can’t put my had behind my back, hurts to move it, significant loss of strength, so this diagnosis wasn’t all that surprising.
Went back to occ health doc and he did another cortisone injection and continued PT. No improvement. Went to my GP who has been giving me prescription painkillers, but I’m sick to death of taking them and the pain never goes away. I’ve been diligent about the PT exercises- do them 3 times a day and have been doing it since late March. My GP finally said to quit the occ health doc (who is supposed to be a shoulder “specialist”, but I do have my doubts now) and referred me to an orthopedic surgeon. My appointment is tomorrow.
I can’t sleep at all (5 hours total sleep in 3 days is not uncommon), am in constant pain (some of it quite agonizing), and have limited movement (thought my passive range of motion is great according to my PT). My question is the following: am I giving up too early with PT if I feel that surgery is my only option to improve things? As I said, I can’t take oral NSAIDs, cortisone did nothing, and insurance denied a topical NSAID. I guess I’m just wondering if I have given PT enough “time” or if it might be time to look toward surgery.
Thank you so much for this website. I have learned a lot by reading all the pages. I truly believe that you are the type of physician who cares about people – and that isn’t always the case – and your kindness is both exemplary and appreciated.
The subscapularis is the most important of all 4 of the rotator cuff muscles. IF your exam is consistent with the MRI reading you MIGHT need to consider having it repaired… but w/o examining you I can not say for sure.
Good Luck!
Tina Trombley
Hi I had a MRI and this is what it said . Full thickness of the supraspinatus tendon at the foot print with 5mm of tendon retaction also infrastructure and subscapularis tendinitis. Suspicion of a superior labradorite teat, small joint effusion with fluid present in the sub across all subject old bursa. I can’t see my Dr for 2 weeks yet can you please tell me anything? What is your opuon. Thanks , Tina
HI Tina… great question. Please feel free to reach out to me on Curely — Where I answer everyones questions. The app can be found at https://www.curely.co Curely allows communication via text or email. Curely is a global platform that enables physicians to assist patients from around the globe who have questions before or after their visits with their own physicians.
Howard Luks MD
Dayn
Hi Doctor. I had tricep surgery twice last year, first failed so i needed a second. Right arm was immobilized for 6 months straight. After going back to the gym i noticed pain in my right shoulder, i got an MRI and have a partial susparinatus and partial infasparatus(Not sure of the spelling), a bone spur and arthritis. It’s been 6 month now and have pretty severe pain when i raise my arm above eye level and when i raise my arm over head and move around my shoulder pops and clicks 10-15 times, every time. I have been going to the Chiropractor and he does deep tissue and ultrasound on it and it feels better after. I ice almost nightly and stretch and pop it against a door frame 6-10 times a day. I have been a 5 day a week weight trainer for 30 years straight and when i go do my weight training it seems to really piss it off after with the swelling, pain when raising, etc. My qestion is this, can i keep doing my weight training since i can only do light weights anyway or should i stop completely and rest it with minimal rubber band rotator cuff excersises for a month or 2? And it’s been 6 months now, and it’s no better at all, how long can i expect this to take to heal, best and worst case scenario’s? I have no pain unless i raise above eye level, then major pain. Thanks for your time doc, i really will appreciate your answer.
IF tendinosis in the main issue, themn light weight exercises should be fine. Resistance bands are ok too. Have you considered working with a shoulder PT as well?
JP
Hi Dr. Luks, Great website. Male, aged 37. Played lots of different sports from an early age. Now I like playing tennis and golf. Mild/moderate right shoulder pain for about 9 months. Have had PT which has improved it, but not back to normal. Able to sleep at night and no need for painkllers. ROM is about 90% but internal rotation is restricted. Eventually got MRI which showed a 1cm full thickness tear in supraspinatus with some minor degeneratuve change. I can’t remember a stand out acute injury. Saw shoulder ortho who was not massively enthusiastic about surgery but left it up to me, with an alternative plan to re-image in 6-12months. I love sport and need to play golf at least for my sanity! Any thoughts? Thanks
JP .. IT’s never an easy call. These small tears do bother some people enough, despite proper non-surgical care that they want to have it fixed.
You may wish to consider a repair — but the decision is yours and based on your current assessment of your quality of life. IF the tear is degenerative, then consideration can be given to a repair + augmentation with something like the Rotation Medical Patch to minimize the risk of developing a recurrent tear.
Robin
Hi, Dr. Luks.
I have been having increasing shoulder pain over the past few monhts and have had an MRI. My orthopedic surgeon has scheduled me for surgery on June 4 as the MRI indicates full thickness tear involving the anterior distal most supraspinatus tendon, complex superior labral tear extending from anterior to posterior and into the labral biceps anchor extending into the chondrolabral junction and irregularity of inferior portion of the anterior glenoid. So, in all that, I am not wishing to undergo surgery, which he is saying would be repair of the rotator cuff and bicep, as physical therapy and injections have not made a difference. I live in a very small town with no second opinion available…..thoughts?
Many people with these small degenerative tears can be managed without surgery. The only caveat is that you should be examined every 6-12 months to be sure that the tear doesn’t become larger.
Adam
Hi Howard thank you for the advice, is there anything I could try out to eliminate the possibility of the shoulder injury because where the pain is in my shoulder behind/in between the front delt is nowhere near my bicep? if it was my bicep tendon should I be experiencing disconfort anywhere else because at present it is an isolated pain in my shoulder?
Thank you in advance
Adam
The biceps comes up the front of the shoulder and enters the shoulder joint deep to the rotator cuff and deltoid. It is a common source of shoulder pain in many people.
Adam
Hi there,
I have a very uncomfortable/annoying pain at the front of my shoulder almost as if it was deep behind my front delt, when I push where the pain is it feels like a large tenant that is very sore. I train 6 days a week doing heavy weights as I am currently trying to put some size on, do you think the above symptoms are veering toward’s the possibility that I have damaged my rotatable cuff? I still have full movement but it is just irritatingly painful and I am worried that I might not be able to train which will be a disaster for me as I have worked very hard to get where I am trying to get to and really don’t want to stop. I would be most great full for any advice you can give me.
Many thanks
Adam
HI Adam… obviously without examining you it’s very hard to comment. But the most common source of pain in that region is the biceps tendon.
Stephen
Hello Dr. Luks, I came upon your website and found with it a wealth of information. I am a relatively fit 61 y/o man. While walking on a fitness trail 7 weeks ago, I stopped and decided to do some dips on parallel bars that were set up for that purpose. I was on my second or third and heard a reasonably loud pop in my right shoulder. It was immediately painful and weak. I was on vacation so I was without my usual support. Went home the next day and began conservative treatment with homeopathy, gentle stretch, high power laser, ultrasound, interferrential, and massage. I have regained almost complete ROM, but strength is taking longer.
I use resistance bands routinely. The motion of a dip exercise still elicits pain, as do most posterior directed stretches. Night is the worst. I get about 3 hours sleep before I wake up with a great deal of aching. I get up and for a couple hours use Traumeel and a heating pad. I can usually get another 3-4 hours after. That has been the pattern for 7 weeks. With the exception of a cycling accident I have never had an injury that took so long. My wife is concerned. I have not sought additional medical intervention, because I prefer to accomplish the healing naturally. Can you please suggest something that you think I am missing.
Thank you for your time!
Dr. Stephen Feldman
HI Stephen …
There are two main reasons that our shoulders feel weak. The first is usually due to cuff tendinosis. That will lead to pain, and your body simply will not be able to exert through the pain and thus the shoulder will feel weak and possibly appear weak in exam. The second reason is simply that you tore your rotator cuff. A large tear, either anterior-superior (Supraspinatus and Subscapularis) or Posterior-Superior (SST, IST) is necessary to cause significant weakness. Ignoring these for too long following an injury might lead to atrophy, fatty replacement and tendon retraction. I would consider an Ultrasound or MRI to assess the integrity of your rotator cuff at this point. If they find a small degenerative tear then you can continue with physical therapy. If however a large or massive tear is found, then a decision will need to be made based upon the degree of atrophy, retraction, your desires, and the likelihood of success.
Best of Luck !!!
Howard Luks
JD
Dr. Luks,
I’m not sure if this thread is still active…but here’s hoping you can help me.
I have had ongoing pain in both shoulders for some time. About six months ago had x-rays of both – nothing of note there. Dr. prescribed PT and I have done a home course of it, but not consistently as prescribed because it caused more pain in my neck/back and I am/was too weak to do all the reps/sets advised. About four days ago I was laying on my bed with my arm above my head (the good arm at the time), and when I went to get up it felt like things were out of place in my shoulder, very painful and I could not raise nor lower my arm without help. I was not able to move my arm away from my body at first, then yesterday only possible to the side but not forward or backwards (except I could move forward from the elbow only). Today I can finally touch my face/head, but cannot keep my arm elevated nor still raise it out in front of me without help. I believe, from what I have read that I have torn something within my rotator cuff. However, since I am having some progress (less problems dressing and able to feed myself with the proper hand again, but still with struggle), I am assuming that the damage is not major and can heal itself. Based on this description do you think that is possible? And if so…how long could be expected before I may gain full range of motion?
Thank you for any advise you can impart!
HI JD … It does sound like your rotator cuff is the source of your pain. A shoulder with bursitis or tendinosis can hurt as much as a shoulder with a tear. Only a solid exam by a shoulder doc and perhaps imaging if needed can tell you what the nature of the “damage” is.
Good Luck
Howard Luks
Vee
Doctor, My MRI showed a Partial thickness 12mm tear in the supraspinatus tendon. It is an articular surface, insertional tear involving the anterior 12 mm of the supraspinatus tendon measuring 5.3 mm in thickness ( approx 65-70 % of tendon thickness).
I am 65 and play golf regularly and would like to continue playing.
My doctor has recommended surgery and then PT but I’ve talked to several golfers who say I should try just PT.
My surgery is scheduled 3 days from now and I’m having second thoughts !
What would you suggest ?
Thank you
Vee … The scientific literature shows that PT can work equally as well as surgery in terms of restoring your function with a small degenerative tear like this.
Gary
Have had rotator cuff surgery twice on my right shoulder. Doctor said last time there was not much to work with. It is still bothering me AND now my left shoulder hurts in the same way as I felt with the first injury on my right. Is it possible to have a tear in both shoulders and if so, how can I live with it. It especially hurts when sleeping on either side. I do not know what to do. I will be 62 years old soon. Any help?
HI Gary… the most common cause of tears is rotator cuff degeneration. This is somewhat pre-programmed by your DNA and genetics… so, yes — it can occur in both shoulders.
There are options available .. but you need to find a solid shoulder doc to review your options. The options available will depend on the current status and quality of your rotator cuff and your xray. At this point, a straight forward repair … even your routine second attempt have very low success rates. With some patients, using a Graft Jacket might be an option, others might need a more invasive procedure … but you need to find a good revision shoulder surgeon in your region.
Good Luck
Howard Luks
Derrick
Dr. Luks,
Thank you for your clear and informative blog. I am learning a lot!
I am almost 48 years old, male, and an avid weight trainer. I have managed to actually increase strength from my 20’s and 30’s, through smarter training methods, improved neuromuscular control, better form, etc.. Injuries have been a part of the deal since childhood, usually due to overuse, or poor mobility.
A few years ago, I injured my subscapularis on my right, dominant side with an ill advised heavy chin up set with no warm up. I couldn’t lift my arm for several days, and was in a lot of pain.
I kept training as possible, doing mobility warm ups and stretches daily. The good news is that over the course of a year or so, the shoulder healed perfectly with no loss of range of motion. My strength then picked up where it left off, and surpassed previous levels.
Fast forward to late last year. I injured the same muscle on the other side, overhead pressing. This one seems to be very slow to heal. Any pressing in any plane seems to irritate it, and send it into spasm. This includes night pain, clicking and popping, seizing up and locking, etc.
The odd thing is that I can generally warm up, and loosen the muscle up with plenty of tedious stretching and resistance band rotations, aggressive myofascial release techniques, etc. Then I am able to do pushups or light presses overhead.
A few months ago, my bench press strength was almost all the way back, and then I “re-injured” it with far less load doing pushups! The overhead press remains problematic.
The fact that I can achieve ranges of motion, albeit with light weights, leads me to suspect that the muscle and tendon is not injured, but rather in some type of chronic, painful spasm. I can sometimes “fool” it into pain-free loaded movement. It helps greatly to keep the shoulder on stretch as much as possible. So when I drive, I have one arm perched over and back, and that buys me some movement for a bit. But then it is quick to tighten back up!
(FWIW, I went through the same thing previously with back spasms, (terrible), but over time learned to restore ROM, relax my psoas and lumbar erectors, and my back has never been stronger and healthier, knock on wood.)
Is this possible, or am I just kidding myself? My experience over 40-years of training, and lots of injuries is that once ROM goes away, it does not come back through passive measures!
I fear that once I surrender an exercise, or a range of motion, that it will be gone forever, and this concerns me a great deal. On the other hand, I don’t want to damage tissue to the point of no return!
How do I know when I might be doing more harm than good?
Long question, thank you for your indulgence.
HI D …
This is a case where an solid exam is needed to determine that status of your rotator cuff and scapula stabilizers. Then a diagnosis can be made, as well as a thought on prognosis and treatment.
Good Luck !
Margaret
My MRI shows a large full thickness tear of the rotator cuff. I have been told I must have surgery or I will lose movement from my shoulder to my elbow and only be able to move my arm from my elbow down this has frightened me but I am still not happy about having the surgery. I would like to know what the percentage of this happening if I do not have the surgery and can my shoulder improve over time.
Many Thanks
Margaret
Margaret,
Tears will progress in size in some patients and not in others. If the tear size does become larger it can reach the point where your motion and strength are significantly affected.
It’s a tough situation. Good Luck!
Howard Luks
Nick
Dear Dr Luks, I hope you can advise. I am a 53 year old male, in good health. I’ve always been a keen swimmer and tennis player. Started getting a bit of pain from serving and overheads a few years ago, so stopped playing in matches but otherwise okay. Back in Feb, I went to the gym (after long gap) and lifted some weights – big mistake. Pain and irritation in both shoulders. Couldn’t lift my right arm out of the water when swimming. Then I wrenched the right shoulder grabbing for something I’d dropped – extreme pain, felt like something had torn above the shoulder blade. Since then, the shoulder/arm has felt weak, unstable, with very limited movement – can’t lift it above shoulder height or extend it in any direction, it just flops back to the side. Almost continuous dull ache in the joint, down the outside of the arm, which gets worse at night. Can’t find any position that’s comfortable to sleep. Was recommended physio by doctor but that seems to have made it worse. I haven’t worn a brace or sling but notice the deltoid has started to atrophy compared to left side. Right shoulder blade also sticks out more than the left and feels odd. So..l’m thinking it’s probably a rotator cuff tear. My question is…. have I left it too late for surgery, i.e. 4 months after injury? I’m not at all keen on the idea of surgery, is there any chance of healing this through careful exercise? Apologies for the long post. Any advice much appreciated. Regards, Nick
Nick… I would not put off a visit to a shoulder doctor much longer. 4 months is not a particularly long time … We can’t answer the other questions until you know what the issue is.
Good Luck
Howard Luks
Dawn
Great informative website
I had an acute injury 9 mths ago that involved my Subscapularis tear from an MRI… I am in severe pain as a result of adhesive capsulitis and had a capsular release about 4 wks ago. The internal rotation is painful feels like front of shoulder is being pressed outward when I try to push myself up off the floor or try to reach other shoulder..can’t put hand on my hip or pressure on my belly…..is this a subscapularis problem even though its a small full thickness? Does this reguire surgical intervention if cortisone shots or physiotherapy isn’t successful?
Thanks!,
Hi Dawn..
Subscapularis tendon tears can be a problem. It is probably the most important of the 4 rotator cuff muscles, and if it is partially torn then the biceps tendon, which is just next to the subscapularis can become “unstable” and move around too much, or even come out of its groove and sit underneath the subscapularis. So, there are many reasons why subscapularis tears can be an issue, and many reasons why it can hurt the front of your shoulder. Time to have a long talk with your shoulder doc… or seek another opinion.
Hope this helps!
Howard Luks
Sylvia
Your website is really informative. Thanks for taking the time. I had MRI today, because I have pain in my shoulders for about 6 month, not able to move left behind the back to the bra or above the head. Also night pain. I am a musician, play harp and started in the fall to prepare for a concert after I hadn’t played for years. I noticed that my arms were very tired and after the concert I stopped playing to give it rest, but it got worse over the last month. The MRI confirmed calcium deposits ( my mom, also a harpist has the same condition!) but also a partial tear. Is the injection and washing out the deposit usually the relieve of the pain? Or will surgery for the torn tendon be needed? What is surgery – sowing the tendon back to the muscle? And what is the connection between the calcium deposit and the tear? Where does the calcium deposit come from? I am also confused as to whether i should let my arm rest or exercise (some of my yoga ex I cant do anymore) Please help me answer these questions to decide for some treatment. Thx so much
Sylvia… Calcific tendonitis can be a self limiting condition… that means the calcium can dissolve and go away on its own. Many people are so uncomfortable that they choose to have the ultrasound guided injection to wash the calcium away. In NY I have 3 fabulous radiologists I use for this. Some Orthopedists can do it… but it takes a lot of Ultrasound skills that most surgeons do not have. You can ignore the partial tear right now… your pain is likely due to the calcium.
Good Luck
Howard Luks
Nancy
Hi Dr. My son is 16 and a catcher on his varsity team. He has pain in the front of his throwing arm – only when he throws. His trainer – affiliated with a local sports medicine group – has done some tests and the only one that was an issue showed some weakness with arms straight out and less strength in throwing arm. She advised using bands and exercising with them to strengthen muscle. Said MRI our “choice”? How does this sound? Thank you!
Hi Nancy..Weakness in a young thrower… if it’s actually there can be due to a pinched nerve at the level of the shoulder. Sometimes pitchers develop a labral tear, which leads to a cyst and that cyst compresses the nerve. Neither the cyst nor compression is dangerous but only an MRI can show you if it exists. I would start with a good exam by a good Shoulder trained Orthopedist. Then determine which test is necessary.
Howard Luks
Daphne
I have just turned 18 and for the last two years my shoulder has been getting steadily worse. When I rotate it forwards or back it makes 3-4 clicking or popping noises. In the morning my shoulder is stiff and the clicking becomes more of a cracking sound. I have gone to the hospital and gotten an X-ray but I was wondering if you could give me any suggestions about what it may be based on these symptoms?
Sorry Daphne … without examining you I can not say why you are having these symptoms.
Time to see a shoulder doc if you are concerned.
Howard Luks
mark haugarth
thanks for the info Dr. Luks. Have had shoulder pain for many years. Started injections in 2013. Suffered a complete long head bicep tare May 2014. Mri after tare showed a 4 cm tear in the upper rotator cuff tendon. Over 65 but still work out in the gym, lift and golf. Doctor is leaving it up to me. If I choose surgery can he reattach bicep? If I choose no surgery what will happen as far as mobility in my shoulder if the entire tendon tares?
HI Mark…
If the entire tendon tears, then your shoulder function/motion might be very poor.
There are prognostic indicators you can discuss with your doctor. It the tear “retracted” away from the bone? Is there atrophy of the torn muscle? Is the tendon thick or thin? That might help with your decision making process.
Howard Luks
Amanda
Dear Howard,
I had surgery on my shoulder to basically clean it out and give me more room because it was pinching a nerve or something, but now a year later I am having pain again but it is when I rotate it or twist it, it hurts some if I lift it but it is more pain when rotation. Could it just be inflammation?
Hard to say Amanda… it might be your rotator cuff that is bothering you. The most common source of pain in the shoulder in adults is rotator cuff “tendinosis”. Some people have terrible pain, but no tears. A good exam is necessary to tell what the probable source of your pain is.
Good Luck
Howard Luks
Sidhu
Dear Howard ,
I started having pain in my right shoulder.Then I decided to do a MRI. The findings were as follows:
1. A large full thickness tear of the right supraspinatus tendon with mild atrophy of the supraspinatus and infraspinatus muscles.
2. Suggestion of SLAP 2 lesion.
3. SASD bursitis and ACJ osteoarthritis.
The gap of the tear measures 1.3 cm in long axis and 1.8 cm in short axis.
Do you think my tear is severe .i am not quite sure how successful the surgery would be as I am quite reluctant to jump into surgery without first finding alternative methods of treatment.
The above scares me as if I have a serious problem, not understanding the medical jargon used.However I have no problems sleeping.i can move my hand to back of my neck with slight pain and do most things with slight pain .
Assuming Ido nothing about it what will be the consequence .
Thank you.
These are not uncommon findings… certain rotator cuff tears need to be fixed, others do not. Very few SLAP lesion needs to be fixed in adults. I think it’s time to have a long sit down with your surgeon.
Howard Luks
lisa
I am 53 years old and had a fall 1 week ago. I fell head first into a railing with my arms out stretched. I do not remember hitting my shoulder. right away after the fall my rt arm/hand started swelling and went numb. I used ice and motrin until swelling went away,about 3 days. I now have shoulder pain and can’t lift or abduct my arm without extreme pain/weakness. However I can put my arm behind by back without much difficulty and I do not have pain when I sleep on the affected arm.Would that indicate that I do not have a rct? Had xray and I do not have a fracture. Othopedist wants to do mri. I want to hold off doing one because I feel that I might just have a sprain. I have started physical therapy. Also sometimes it is harder to bring my arm down than to raise it. What are your thoughts??
With this type of injury and your complaints, an MRI might be the way to go. I would base that decision on the findings and your physical exam.
IF you have a traumatic rotator cuff tear … it’s better to know sooner rather than later.
Good luck
/hjl
Diane P
Hi Dr. Luks,
I would like your advice regarding my rotator cup tear. I went to my doctor yesterday to go over the results of my MRI. I’ve been having pain in my right shoulder and below the shoulder for over a year now. I injured the shoulder while cleaning out horse stalls.
I did some physical therapy back in April–before the doctor ever took an MRI or X-ray; The therapy didn’t help as it was geared towards shoulder impringement and it started to hurt when I would use the rubber band.
The doctor said I most likely had an incomplete tear of the rotator cuff along with Calcific Tendonitis. Then, he left it at that and told me to take some Advil to relieve the pain. He didn’t suggest the surgery because I have ITP (now in remission–platelet disorder). I did say that if I did have surgery I would have to be admitted into the hospital just in case my platelets started to fall; otherwise, I would be a little scared of the surgery.
I am 65 years old and am very active for my age. I swim, workout, and ride horses. I really would like to do something about this constant pain and was disappointed when the doctor didn’t suggest some more PT or something else. I am really tired of just “dealing” with it.
What are your suggestions? I am right now looking for another Orthopaedic doctor to get a second opinion (and, by the way, the doctor spend probably 5-8 minutes with me going over all of this).
I would appreciate any of your advice.
Thank you,
Diane
Diane… I’m not quite clear. Did the MRI show a full or partial rotator cuff tear? If it showed calcific tendonitis.. and the X-ray should show that quite clearly then you may want to discuss an Ultrasound guided injection to wash the calcium out of the rotator cuff. Calcific tendonitis is a well documented cause of significant shoulder pain.
Good Luck
Howard Luks
mir
hi there! I had experienced a fall year ago which caused massive pain in my shoulder i had an x-ray and no bone damage but i cant play cricket or any sport that requires the rotation of the arm with a jerk i hear a pop sound and my should feels like its been dislocated and then i hear another pop and the arms all fine but it hurts for a week then is it rotator cuff damage? If it is then is it a partial tear? Acute or worse? Do i require surgery
mir
oh and i want to add that i can reach objects far away or on top shelves of a cupboard but i can not play sports
Mir… sounds more like a case of instability where the joint may be dislocating and then reducing itself. Please see a shoulder specialist.
Good Luck
Michael
I was just diagnosed with full thickness tear, 12mm in length. also hypotrophy of acromioclavicular joint. I have a friend who is a retired orthopedic surgeon tells me the tear may not be giving me all the night pain ,but the hypotrophy of the joint is. At times I have full movement of my shoulder and times I need to support it with other arm. Night pain has been constant and almost unbearable. My friend says that fixing the joint may be all that has to be done. Fixing the tear is a long hard road. Advises me to see surgeon for second opinion. What are your thoughts?
Hi Michael…
Many many people have ACJ arthropathy- or arthritis on their MRIs. Most of them do not have pain in the AC joint. Just because it is arthritic doesn’t mean it’s going to hurt. The rotator cuff is the number one offender around the shoulder when it comes to night pain. The night pain can be awful. As very easy way to determine if the AC Joint is the source of your pain is to have your doctor examine you, and possibly inject it with lidocaine. IF your pain goes away then the ACJ is part of the problem. If your pain does not go away then the rotator cuff is the likely cause of your night pain.
Hope this help.
Good Luck
Vicjel Ingal
What should I be expecting after I get my right shoulder surgery? Doctor says it is a 5mms tear, though that was 4months ago. Now I believe my tear surpass 5mms due to heavy lifting work, construction, and have this tear for a year now.
I will be having the surgery by Summer 20014 and the doctor said it’ll take at most a month process to get better.
though within that month, what will I be experiencing and when I should I be able to return to my Lifting weights routine?
Thank you for having your time to reply.
a 5 mm tear is really really small … are you having surgery because other treatments have failed? I would also be very very cautious about thinking that you will be back to “normal” in one month. Most rotator cuff repair patients will tell you in took them 4-12 months or more to “get better” .
Good Luck… but consider a second opinion
Vicjel Ingal
I got my MRI scan result September 2013 and it was 5mm.
Reason why doctor should fix my tear is because any treatment they gave all failed. The ibuprofen, Injection Steriods shot direct to the tear and many more. So only way to get better is surgery as they stated.
My Ligament/Labrum is what got torn, to clarify that.
Though I am curious what I will be facing after the surgery?
of how u said 4-12 months to get better, will I be able to do small resistance weights? Or suggest a different excerise after my surgery?
Name debbie
Hi, my name is Debbie. I tripped and fell and hit my shoulder onto a pavement with my right hand in an awkward position. The first initial diagnosis by the ER doctors was just a shoulder strain. However, I could not lift my right arm up in front nor to the side. I went to see an Ortho doctor and he suspected a torn rotator cuff due to weakness. I had an MRI done and the results is a full-thickness full width tear of the supraspinatus and infraspinatus tendons at the footprint with retraction 10 mm lateral to the glenoid. Mild to moderate atrophy and fatty infiltration of the supraspinatus and infraspinatus muscles. I never had any shoulder problems before. My Ortho doctor recommends arthroscopic surgery to repair the rotator cuff. I was hoping to get surgery this week thus 4 weeks since injury, but could not because there were no openings. I am having the surgery at the end of this month which would be 6 weeks since my injury. My concern is that since this is an acute large rotator cuff tear, If I don’t get surgery within a certain timeframe the rotator cuff might not be repairable and outcome not too good. What’s your thoughts?
When should one get surgery after experiencing acute traumatic injury which tears your rotator cuff completely in order for it to be repairable and good outcome? Could a delay in surgery promote more atrophy and fatty infiltration of the supraspinatus and infraspinatus muscles and bigger retraction of the tendon so that it is harder to repair and outcome becomes less desirable?
Thanks,
Debbie
Debbie .. Sorry about your injury. Kudos for doing your research! Another two weeks should not make a big difference. 2 cm of retraction is not insignificant, but an accomplished surgeon should be able to repair it.
If you’re comfortable with your surgeon, you should be ok with waiting another few weeks.
Best of luck
Howard Luks
NameLorri
Hi, my name is Lorri and I have been dealing with a rotator cuff tear for over 13 years. At age 56 now, it has started to give me massive pain. They did an MRI and found a tumor in my bicep Tendon sheath. They removed it and I still hurt from the surgery over 3 months ago. I had been on pain medicine for over 4 years with this arm and I had enough. They scheduled me for surgery to fix the first surgery because now that hurts worse than before. The surgeon stated that it is because it has now fraged away and he just wants to cut it and let it attach itself back to something instead of anchoring it down. Okay then I have a full-thinkness tear on my supraspinatus tendon and two partial tears they say in the back of my shoulder. I cancelled surgery and started to work out pretty hard. Today, I have full range of motion back; yes it hurts almost everyday, but the pain level is something I can live with. Having the surgery to me, was not the fix. I built up my muscle and have learned to do things in order to keep the pain down. Maybe later now I will really have to have another surgery but for now, I am NOT going through that pain after surgery. Good luck to everyone and I hope reading this gives you choices to make.
thanks for sharing with us Lori!
Name Jeff
I have constant pain in my arm. It is constant, a 6-8 pain level. I have osteoarthritis of the glenohumerl head.
The long head of my bicep tendon is not visible in MRI, and the supraspinatus tendon is torn and retracted. Is there any hope that I can have someone fix this mess so I can get off of high dose morphine?
Thank you,
Jeff
Morphine is a very poor choice for managing chronic arthritic pain. There are treatments for patients with osteoarthritis and poor rotator cuff coverage. Find a good shoulder specialist in your area who can evaluate you and apprise you of your options.
Good Luck Jeff
Robert Jones
Hi, thank you for this incredible website. Around 1 1/2 years ago I started having incredible pain a few hours after bench pressing.
To start with I’ve had trouble with my left shoulder since I was a kid and fell down a tree. When I tried to catch myself I hurt my shoulder. It eventually got better, and I didn’t think anything of it until just recently.
The pain I described after benching was not evident while I was bench pressing. It was only a few hours afterwards that I began to feel it. At the time, I took a few days off and felt better, so I tried benching again. This time, a few hours later it was worse than ever and I experienced a numbing sensation in my left hand specifically my left thumb, index and middle fingers. This lasted 6 to 7 months.
I took around a year off from lifting weights and had moderate atrophy in my left triceps and pectoral muscles. 6 months ago I began lifting again, but went from 100 pound dumbbells pre-injury to barely being able to bench a 50 pound dumbbell with my left arm for one repetition. I’ve worked really hard and have managed to do 5 to 6 repetitions with 65 pounds now, but after 6 months I was hoping for more progress.
I went to a generalist after the first injury, but was given Motrin and sent on my way. I’m sure I could benefit from surgery, but I would like to have an idea on what I might be in for. Thank you for your reply!
Robert Jones
Robert…
Thank you for the very kind comments!
Your probably injured your labrum as a child… but I doubt that it what’s bothering you now. Most adults who work out often have pain because of their rotator cuff, or a little joint on top of the shoulder called the AC Joint. It would help me a lot more to know where the pain is. It also sounds like it’s time to see a sports doc and potentially have an MRI. The numbness and tingling is something else altogether… either a case of carpal tunnel syndrome or a problem with the nerves coming out of the neck ???
Come back and fill me in!
Howard Luks
nebojsa
I injured and dislocated my shoulder at a MMA match.. i fell on a outstreched arm. I never had problems with that shoulder, i had problems with the other one, witch by now healed. sometimes i fell it tearing while performing a front jab and it goes away in a day or two… But i can lift 308 lbs/140 kg on bench press with no problem what so ever… heavy weights don’t botter me. Can somebody please give my an advice what should i do. I did an x-ray when i first injured it and it came as ok…
Thanks. (sorry for bad english)
You may be having pain because of a labral or cartilage tear which occurred when you dislocated your shoulder. These tears are very common after a dislocation. One of the problems with this type of tear is that you might have recurrent instability where the shoulder is trying to slide out of place with certain maneuvers. I would suggest that an evaluation by a good shoulder doc and a possible MRI at a good facility would be the next step.
Good Luck
Howard Luks
nebojsa
Thank you so much for your quick response. I think you’re spot on. Just wanted to ask one more question. Does that cind of tear require surgery? I take collagen suplements and sometimes mix glucosamine+MSM.
Can’t thank you enough :)
nebojsa
kind*
lana
I’m having surgery 12-12-13. Can you tell me if this for sure needs surgery. I’m in awful pain & just dont think I can go any longer like this. I have been taking naproxen which absolutely helps. I feel that my visit with Dr went so fast that I didnt get to really ask anything.
Can you please tell me what this all means?
MRI reading
There is a slap tear
There is high-grade articular sided an intrasubstance tear of the supraspinatus tendon which may have focale full-thickness extension. There is associated tendinosis.
There is a moderate grade intrasubstance tear of the subscapularis tendon w/associated tendinosis & mild medial subluxation of the tendon of the long head of the biceps into the subcapularis tendon.
There is mild tendinosis of the infraspinatus tendon.
There are mildly degenerative changes & a moderate amount of fluid in the subacromial-subdeltoid bursa.
One more thing Id like to ask, if this report is bad, would this explain pain down the front of my chest?
Thank You for any help
Lana… I have to ask.. if you’re not sure what is wrong… and you’re not sure what the doctor is doing or whether or not it is absolutely necessary then why are you having surgery and not seeking another more valuable opinion. The findings on your MRI are not uncommon — very very very few people have “normal” MRIs. Any number of things might cause pain.. but we treat patients and not MRI findings. What I mean is that your doc needs to have a solid understanding of what hurts so he knows what he needs to address. Is he/she performing a labral repain? Why? (few people need it)… Is he/she performing a rotator cuff procedure? How are they going to address the biceps in the front of the shoulder? These are all very important things to explore with a surgeon who is willing to sit down with you and explain what your options are and help you make an informed decision… and have a clear understanding about the prognosis and recovery is.
I hope this helps!
Howard Luks
Steve Q
Dr. Luks,
Separated my shoulder about a year ago playing basketball. Orthopedic in Stamford CT diagnosed me with a high Stage 2/low Stage 3 separation that did not require surgery. I lift weights at least 3 to 4 days a week but still have pain doing any sort of chest work (Bench Press, or any other chest exercise). I feel weakness and slight pain when i raise my arm directly in front of me. Could this be a rotator cuff issue? I usually have no problems doing pull ups, back exercises, and shoulder presses.
Steve.. sometimes the rotator cuff or other structures in the shoulder are injured when you sustained your AC separation. In addition, a small percentage of people who have a grade 2 or 3 separation will have pain relating to the AC joint. A good exam should be able to tell you which is the problem, and what the potential solutions are.
Howard Luks
Shani
Dr Luks, I had a bad fall with all my weight landing onto my left shoulder 7 weeks ago. The first day I could not lift my arm at all and the pain was severe. A couple days later what looked like a large black bruise developed on my bicep. The ‘bruise’ did not hurt or feel tender if I touched it. I think it may have been from some internal bleeding in my shoulder that pooled in my arm, is that possible? I have some more motion now but still have quite a bit of pain even when resting. If I try to lift my arm or pick even a glass of water up, the pain is severe. After researching on the web, it seems likely i have a torn rotator cuff but I don’t know the extent of the tear. I am a runner and tried to keep running when I first hurt it then developed terrible muscle spasms in my back, I think as a result of my gait being off from the shoulder injury, so I am totally incapacitated at this point. I have been out of work for a year and have no health insurance and no money to pay cash for medical care. I am worried if I don’t get treatment that I will make it worse and have permanent damage to my shoulder. Is there anything I can do to prevent further damage and treat it on my own without any medical care? The only care I could get would probably be ER visit but it doesn’t seem like they would be able to do much except refer me to a primary care doc or ortho surgeon. Any advice you have would be helpful. Thanks.
Shani .. Sadly, the injury mechanism you sustained can cause a rotator cuff tear. It’s not a guarantee, but a possibility. I can not recommend any specific treatment recommendations other than simple stretching until you know what the actual diagnosis is. Perhaps you can visit a hospital clinic which offers care to the un- or underinsured? Once we know the diagnosis, then a treatment plan can be put into place.
Tim
Dr. Luks, I separated my shoulder years ago (40 or so) when I caught a softball. I dove and was on my left side – left arm extended – when I came down. I thought it had healed up with no problems… and maybe it did. But a couple of months ago, that same shoulder started bothering me. Lost range of motion, hurt to lift it out in front, etc. I slammed the trunk of my car shut and the pain almost took me to my knees. Saw my orthopedic surgeon (knees, neck, etc) and got an MRI. The results are: 1) “Tendonosis of the supraspinatus tendon with a focal full thickness tear identified at the anterior aspect of the tendon at its attachment to the great tuberosity. High grade partial tear versus full thickness tear is identified elsewhere within the anterior portion of the tendon.” there is also some suspicion of a partial tear extending to the bursal surface of the tendon posteriorly. 2) “Abnormal signal within the subscapularis tendon compatible with tendinosis. Partial tear is a consideration as well. No evidence of a full thickness retracted tear.” 3) Abnormal signal within the biceps labral complex as well as between the complex in the underlying glenoid. Degeneration and/or tear in this area is suspected.” And finally 4) Hypertrophic degenerative changes of the acromioclavicular joint.”
I assume that is the AC joint that I damaged playing ball. Will PT help this or am I doomed to have surgery, even if it is arthroscopic? If surgery is recommended, what is the prognosis for recovery? I go back in to see my surgeon on Monday to get his diagnosis/recommendation but was trying to get some info before I went it. I trust him completely – been working with him for several years. I am an older guy (63) who played sports his whole life – football, softball, lacrosse, running, ultrarunning…. things are just wearing out. I knew this would happen at some point but was hoping for later rather than sooner.
george mitchell
I am 68 years old .I shoot basketball daily for 1 hour . About 20 years ago i had a bad fall on some ice landing squarely on my left shoulder . Recently I have had it x-rayed ,it was determined I had small bone fragments causing me pain .I have been getting cordizone shots every 4 months for pain . Recently i began physical therapy and it was going well ,but after a day pulling weeds in the garden I had great pain and was unable to raise my arm above my head ..should I get more x-rays an ultra sound ,what do you recommend ? THANK YOU . GEORGE MITCHELL
Thanks for stopping by George.
I’m not quite sure what you mean by bone fragments :-(. Sometimes we get calcium build up inside our rotator cuff tendons. We call that calcific tendonitis. It can be a very painful condition. Sometimes it resolves over time spontaneously and at times we utilize an ultrasound to localize the calcium and wash it out of the tendon with a syringe full of saline or local anesthetic. Perhaps you can ask your doctor for the more formal diagnosis and I can elaborate on that further if necessary.
Howard Luks
Tracy
Hi Howard
I started having left shoulder pain about four months ago. I went to an Orthopedic office and was seen by a PA. He took an x ray and diagnosed me with frozen shoulder. He gave me a cortisone shot and sent me to physical therapy twice a week. The cortisone shot did not help at all with the pain. My shoulder is alot more painful. I have been pain non stop.. I now have pain all the way down to my wrist and hand. I can’t hardly sleep or eat because I am in so much pain. My physical therapist thinks there is something else going on either in combination with frozen shoulder or something different than frozen shoulder all together. I have had 18 pt sessions and my shoulder is getting worse. My doctor is finally sending me for an MRI. Does what I am describing sound like frozen shoulder or does it sound like something else in your opinion?
Thanks
Tracy
Thanks
Tracy …
The hallmark of a frozen shoulder is stiffness or loss of motion. Sometime it’s significant. Even when someone else tries to move your shoulder they can’t because the shoulder seems “stuck” in position. If you do not want to move the shoulder because of pain… that might be something entirely different. Frozen shoulders can hurt … A LOT! It’s impossible for me to say whether or not you do or do not have a frozen shoulder… perhaps you want to see a second opinion or go to an office where the physician sees the patient too.
Good Luck…
Howard Luks
Ryan
Dr. Luks,
I have been having shoulder “strength/cuff tear” issues for about 3 years. I’m an avid surfer who always wears wetsuits (most fit tight to snug in the shoulders). First pain was in left shoulder, I’ve been participating in yoga and pilates for about 1 year and the left shoulder is almost back to normal! Unfortunately, the right shoulder now has symptoms associated with strength/cuff tears. I believe 90% of my pain is associated with pressure from the wetsuits as the same activities without a wetsuit are almost pain free. Would it be wise to continue the yoga & pilates or start a physical therapy or personal trainer shoulder strength program? Any advice would be appreciated
Thanks, your site is wonderful
Thanks for visiting Ryan… and thanks for the compliments.
Hard to explain why the wet suit would set off the rotator cuff or other muscles and cause significant discomfort. I usually suggest that someone evaluate you, determine what the source of your pain is. And then help design a rehab program for you that might involve PT, Pilates, yoga, etc. Hard for me to suggest a specific program without examining you… hope you understand :-) !
Howard Luks
Taylor
Hi Doctor Luks, you seem to really know what you’re talking about and I wanted to get a second opinion online before paying the money to consult an orthopedic surgeon.
I went to see my general practitioning doctor to get an antibiotic, also for about a week my shoulder had begun to seriously hurt. Very badly in the mornings right when I woke up, to the point that towards the end of the week I was waking up every few hours from the pain, or any time I rolled onto that shoulder in my sleep. I was lifting heavy boxes 2 times that week which I’m not exactly used to, and after the second time, two days later was when the SERIOUS pain started.
Long story short, I saw my doctor and he said that he believes I have a torn rotator cuff in my right shoulder. However because I had been complaining of the pain for about a week, he told me a few exercises to do.
I did them one time, and it hurt me quite to even do them, I was in tears by the end.
Now, 2 days later I could not lift my arm in front of me above 45 degrees, or any type of rotation that would rotate forward/up without massive pain. I can’t really hold anything with weight, and have to support that arm with my other arm when I DO need to use it, because it’s my dominant hand!
I’m very concerned that the exercises he gave me made it much worse and that now it may be a full tear or something.
I cannot afford X-rays or and MRI as my insurance does not cover it. Of course, if it seems extremely bad and painful after another week or so I plan to see the surgeon regardless. SO, what I’m asking is your opinion on if you think it may be a full tear? I’m really trying to avoid rushing to a surgeon, especially as I just had my wisdom teeth removed 3 weeks ago.
Thank you so much in advance, (and sorry for the ranting questions! I’m just in a lot of pain and don’t know what else to do.)
Taylor… It sounds as if your rotator cuff is bothering you. I would certainly have a set of X-rays performed… but it may be too early for an MRI. The most common cause of shoulder pain is rotator cuff tendinosis or a partial tear. Your exercises may have made your shoulder hurt more… but it didn’t cause a tear. Many people are successfully managed and treated with medications and injections and therapy. In this situation, an MRI might be necessary if something unusual shows up on the X-rays or if you fail to improve with a course of non-surgical management.
If you do eventually need an MRI shop around. You will be able to bargain for a cash price!
Good luck!
Howard Luks
Matthew Coriell
I have a question, I hurt my shoulder a year ago, tubing when I fell on it outstretched. I work out with high intensity. I started crossfit about 4 months ago, and I think from just over use it has came back the pain. It hurts when I put on a belt from behind me. I went and did an MRI and it showed a lot of inflammation in my shoulder, also a slight tear on labrum and rotator cuff. My doctor told me to stay off for 6 weeks, which I did, but now I’m back working out and it is still aching. It doesn’t really hurt, it’s just a deep ache I feel like in there. I want to compete in Crossfit, I enjoy everything about the sport, and I’m wondering if I’ll ever be 100%, should I get the surgery even if I’m out for 6 months, and come back to crossfit stronger, or do I keep letting it heal, then working out and it coming back. I just feel like overtime it will get worse. Any advice would be great
While a recovery is certainly possible with and without surgery — it is by no means a guarantee. I have seen many high level athletes return to sports at 100% strength, endurance etc after this type of injury. Perhaps you need to talk with your surgeon about letting a therapist or trainer guide you in your cuff rehab. Go very slow re: surgery as a treatment plan. Your goals are very precisely defined…. and leave a low margin for success.
Good Luck
Howard Luks
Mark
The question I asked regarding apparent movements of the tendons near the surgery site were probably hard to answer realistically without knowing my progress in detail. Time has passed with my shoulder rehab since my query and I am pleased to say now that the movement and noise has settled down almost completely – still quite a way to go and the shoulder is stiff and not as strong as it should be yet, but he issue I had with tendon movement and so on has greatly reduced as the shoulder gets stronger. Thanks again
Mark
Hi Dr Luks you kindly answered my question about clicking in my shoulder after having had surgery to reattach my supraspinatus tendon. Your answer was reassuring. I have realised now though that there is also a very slight movement at the point of the shoulder where I think the supraspinatus tendon would have been attached to the bone. This happens when I raise my arm above my shoulder and is more marked when I am holding a light weight as I have been asked to do for therapy. I am now almost 12 weeks from having the surgery. There is little or no pain associated with this although sometimes the shoulder Is slightly sore overnight. The movement itself seems to be quite slight, as if the tendon or perhaps just part of it is repositioning slightly under the slight strain of weight and movement.
I wonder if you could indicate whether you think this could also to be quite normal in the lengthy healing process. My hope is that some movement under stress is not uncommon at this stage but that given care and rest this will also settle down. It does tend to make some alarm bells ring for me though and tends to make me want to ease up on raising my arm a little and to use only the lightest weights at the moment.. again in the hope that the fix will settle down more in time.
I would be greatly appreciate any thoughts you have. Thanks once again.
tom parker
hi i have loud cracking in my shoulder when i stretch or do weights i dont know what it is thanks help me
Kumar
Please tell me, how much time does it take to fully recover from a shoulder impingement syndrome?
I am 35 yrs of age and getting treatment for Shoulder impingement for last 4 months. Thanks
Therapy and occasionally medications can take a few months to work. If your pain persists, an MRI may tell us why you did not improve.
Kumar
Thank you sir.
Kumar (India)
Please tell me, how much time does it take to fully recover from a shoulder impingement syndrome?
I am 35 yrs of age and getting treatment for Shoulder impingement for last 4 months. Thanx
Sam
Hi, I wana know which one is better an Ultra sound or an MRI to find out if its a rotator cuff tear? and Does jus givin proper rest to the shoulder help the rotator cuff to heal on its own?? Thanks and god bless.
If the person doing and reading the Ultrasound is good… it is as good as an MRI in evaluating the rotator cuff.
Mark
Dr Luks, First of all thank you very much indeed for your time in answering questions online – it is most kind and helpful of you for what are often worrying things for people.
I had rotator cuff surgery 9 or so weeks ago on a full thickness 2.5 cm tear on my supraspinatus tendon. The surgeon tells me the repair was very tight and reliable. The shoulder was very stiff after surgery, partly from before surgery due to freezing or adhesions I am told. Quite aggressive stretching prescribed by the surgeon and my physiotherapist has now freed this up a good deal happily. In general things seem to be progressing well, with light strengthening exercises now started.
My question is. I find after raising my arm above my head with a light weight that when I lower my arm the shoulder “clicks” very slightly but noticeably when I lower the hand to about shoulder level. This is like a tendon moving over or flicking over something and seems in the region of the supraspinatus closer to my neck (I think) than my shoulder (but I can’t be sure exactly of the source of course), I don’t get undue pain with this and strength and movement seem to be coming back slowly. Should I be concerned about this “clicking” or is it more likely just a part of recovering the healthy structure of the shoulder rather than an issue with the repair or something else I should be concerned about. I did ask my physiotherapist but she was not sure but suggested it was probably nothing to worry about.
Obviously I will not take your response to be a definitive answer about my shoulder, but any advice on this kind of thing in general based on the symptom would be greatly appreciated. Thank you again
Clicking in the shoulder is very common.. especially after a rotator cuff repair. As long as things are progressing well it should not be a problem.
Good Luck …
Howard Luks
Denise
I cannot lift my arm upright at all and have really bad pain. Arm is useless and even hurts to type. Is there anyway to get out of this without surgery/ Ouch!!
Denise
Oh forgot to say I fell in the market and heard the tear
Denise… I’m not sure what you’re suffering from :-( Did your Orthopedist say you have a tear? Did an MRI or ultrasound confirm that? Orthopedists tend to treat acute or traumatic tears differently than most tears which are degenerative (where out tissue simply wore out).
NameBarry
Dear Dr. Luks. Your posts are so helpful and I appreciate your caring responses. Does some fraying or partial thikness tear of SP tendon have a high likelihood of becoming a full thickness tear in a 40 + year old with an active shoulder, i e. regular exercise and strengthening or some weightlifting regimen? Is anything beyond physical therapy and better form or guided exercise to do to prevent chance of progression? Thanks very much.
Tonya Owens
I am 34 years old and had shoulder impingement following a minor motor vehicle accident in 2009. Had subacromial decompression in 02/2011…did well until about 6 months ago when I tried regularly incorporating exercise (small hand weights). Mri from November showed arthritis, bursitis, tendinitis and a small tear on my right, dominant shoulder (sup. tendon). My pain has gotten progressively worse and now at night it can be excruciating. My ortho is hesitant to do surgery due to my age and sending me to Gerald Williams at the Rothman Institute. I don’t want my age to be the sole factor in not doing surgery. Any thoughts on this.
Age should not be a significant factor in treatment decisions about rotator cuff related issues. Good luck with your visit with Dr Williams.
Your age will have nothing to do with whether or not surgery, therapy or injections are recommended. Good luck!
Kyla
Hello Dr. Luks,
I have gone to doctors office several times about my shoulder and I have seen an Orthopedic as well. But nobody has figured out why my shoulder hurts. I have gotten contrast with my MRI and nothing. But i recently hurt my shoulder again. And now I am experiencing numbness down my arm and I am afraid that the doctors will tell me the same thing as before. Also, my body does not show tears… I know that may sound silly but it’s true. I injured my knee in high school and the orthopedic did not even see it until he went in and saw a tiny tear. I have tried Physical therapy but that just bothers it and it hurts more. So I guess my question for you is what do you think my problem is? Thank you!!
Kyla
I wish I could tell you Kyla! It’s in situations like this that a thorough history and physical exam is of paramount importance. MRIs should be used to confirm diagnoses around the shoulder… not necessarily to make the diagnosis.
Good Luck !
Howard Luks
Lisa
I have been having pain in my shoulder for 3-4 years. I had the pain treated twice with oral steroids. Recently, was in excruciating pain and called an orthopedic doctor. The MRI results were…Focal near full-thickness rotator cuff tear. Also states in the summary 3 mm gap at the site of the tear, along with findings of calcific tendinitis. I’m not sure if I should get a second opinion. I’ve already scheduled surgery for March 20th. Is it possible that the tendinitis is causing the pain and not the tear? I forgot to mention that I went through three months of physical therapy recently and it did not help. Pain when moving my arm up and pain at night. Any suggestions??
Thanks,
Lisa (46 years old)
In all likelihood it is the calcific tendonitis that is producing the pain… but without examining you it is impossible to know for sure. Many many of us have had significant success with Ultrasound guided injections of the calcium deposit which washes the deposit out of your shoulder… thus eliminating the need for surgery. Most academic shoulder surgeons typically do not get very aggressive with tiny rotator cuff tears… although we do watch them to make sure they do not become larger (most do not).
Good Luck
Howard Luks MD
Bob
I have 3 tears in my rotator cuff from a fall and a possible tear in the labrum i have constant pain over the top of the humeral head. I wake 4 times a night to move my arm to where it feels more comfortable. I have done PT for 5 months to no avail pain is still there and can not regain strength. Could surgery help me regain my strength and reduce the pain?
It’s certainly possible… the success rate in terms of pain relief is very high but the success rate is also determined by a number of factors such as the size of your tear, the degree of “retraction” or “atrophy” as well as other factors. Time to have a meaningful sit down with your surgeon to discuss the alternatives.
Good Luck
Tony
it is my right arm
Tony
Dr. Howard,
I have had shoulder pain for over a year now, and I think it came from weight lifting. I am a heavy lifter and play football, and for the past year it has pained me to lift heavy bench, shoulder workouts, push press, pretty much any motion lifting my arms or holding something out in front of me. I am now a college athlete, and really need to figure out what is wrong. I feel it in my side delt mostly, sometimes in anterior delt as well. Do you have any ideas?
Thanks
Pain in the shoulder in young athletes is typically from the AC Joint, a labral tear or a rotator cuff overuse injury. It is almost never due to a rotator cuff tear. Without evaluating you I really can’t offer an opinion as to why your shoulder is bothering you. I hope you are able to find a great sports doc who can assist you!
Howard Luks
Names Sharon
Wow really, because yes that is what he is saying, bone spur, if I can’t live with the pain then have the surgery, 94 to 95 percent the pain will be gone, no talk about the tears..
Don’t know what to do…
Thanks…
Second opinion… hopefully at an academic center by a trusted shoulder surgeon.
Names Sharon
Hi Sharon again, that is what mt doctor said. He did a MRI back in August, then sent me to pt. never did he talk about this bone spur just the tears. Now since doing pt since August and still having pain, I went back to him to see what to do. Now all of a sudden he tells me I have a bone spur, and if I can’t live with the pain he will do surgery.. It bothers me that he didn’t talk about this bone spur before. Why would he not had talk about the spur right from the get go, and should I do the surgery. It sounds like he will go in and clean up the bone spur, and said while he is in there look at the tear see how it looks. His main reason is bone spur, what odd you think???
Thanks!!!!
I would be wary about anyone talking bone spurs as the source of pain… as I mentioned in my last response… the thought that they cause shoulder pain has really fallen out of favor.
Names Sharon
I have tears in both shoulders, now doctor said i have bone spur in left one. If he fixes bone spur and don’t have to fix tear will the pain just go away from the top of my shoulder or will it help the pain in the front of my shoulder which I think is from the tear. I have already gone through pt.
Thanks for stopping by Sharon… the thought that a “bone spur” is the source of shoulder pain started to die away as a concept many many years ago. Today, most academic shoulder surgeons very very rarely go after bone spurs or look at them as a source of pain.
I wish you luck in your pursuit for pain relief!
Howard Luks
Karidene Eaton
I have recently found that I have lost significant range of motion in my right arm, I cannot raise my arm fully over my head, yet there is no pain at all. Is it possible that I have a torn rotator cuff of some sort?
Could be related to your rotator cuff or something we call a frozen shoulder. Other less common diagnoses possible. Time to see a good shoulder surgeon.
Good Luck
Howard Luks MD
NameEddie
M right should tip bone is higher than my left. I have no pain, when I raise my arms straight out I have a bigger hole(void) on my right shoulder than my left. I hurt my shoulder 20yrs ago playing softball diving for a ball, jamming my shoulder upward. I had it checked out but no surgery. I had no pain lifting and had complete motion, the only time would be when I throw a ball. That is doing a full throw, but if I only cocked my arm halfway back I have no pain. I fell a month ago mtn biking, and this is the time I noticed the void and my right shoulder higher than my left. I stll have no pain and full range. Please advise.
Jim
WIth a full thickness tear, how long does one typically have before the tendon retracts or the body turns the tendon to fat?
Thank you in advance for your comments?
Welcome Jim … great question. Tendon retraction occurs in large tears involving one or more of the 4 rotator cuff muscles (and tendons). Many tears are small and recent literature has shown that they do not increase in size or retract. Fatty atrophy, where the muscle turns to fat is an interesting phenomena. It also tends to occur with larger tears. The sad thing is some studies show that it worsens after a repair, and never reverses back into a normal muscle after it has occurred.
Hope that answers your question.
Howard Luks MD
keon
also my shoulder feels a little weak compared to my left one.
keon
i was benching about 95lb because it was my first time. then i heard tearing or popping on my right shoulder. it did not hurt for 2 days but just sore and on third day i went to play basketball with my friends and that night my shoulder pain was so great that i couldnt go to sleep. the pain went away after 3days. the only thing that is bothering me is little discomfort in my right shoulder. i did some online research and im really confused. i have full range of arm motion and the pain was in front of my right shoulder. Could this be a large rotator cuff tear?
Could it be, yes… is it likely, no. AS I say throughout my site, some people with large tears have moderate, mild or no pain — and some people with severe pain can’t sleep and complain of severe pain with active use. The amount of shoulder pain that someone has does not correlate with the size of their tear.
Hope this help~!
Thanks for your commments
HJL
keon
Then what could be causing discomfort in shoulder?
NameDiane
I fell 4 wks. ago,and had an MRI done early July. Dr. sais to try physical therapy. Today, the therapist siad I have a full thickness tear,and,should consult witha surgeon! Is she qualified to read the
MRI report?
Thanks,so much!
Reading the report is easy! Knowing what to do next is not. We treat patients, not MRI findings. Not all tears need surgery. I have many other posts that go into that. Try here … http://goo.gl/btYfN
Good luck…
Howard Luks
Jonny
Hey Howard,
My shoulders hurt a lot when I raise my arms to the side for too long. Perhaps only a minute before it starts to ache. Both also dislocate and rejoin when I bend my elbow and move my shoulders backwards. Its this a sign of a large tear? I have had this for a year now.
J,
Shoulders can dislocate for many reasons. Loose ligaments, torn ligaments and very large rotator cuff tears. Pain with instability (dislocations) is not unusual because your muscles around the shoulder are working very hard to try and keep the joint stable and located. A complete history (your story), a good physical exam and perhaps an MRI will give you a reason why your shoulders are dislocating and why you have such pain.
Howard Luks, MD
Westchester County, NY
Michael
Howard,
I did something to mine on 8/27 of this year. That night and for the next 6wks I could not lift my arm. I had ROM from where my elbow could bend but that was it :/
3months later I have a little bit of the ROM back and from reading a post above I thought my back was spasm out due to possibly overcompensating with one side of my body. from my shoulder, where the injury is, and down both sides of my back it is horriable pain.
I addressed it with my ortho and he prescribed more PT awaiting the results of the MRI.
Are the 2 not related, the injury to the rotary cuff and the back spasms, tension?
Thanks in advance,
Michael
MIchael… sometime when our shoulder is bothering us… and we do not move it “normally” we start to compensate and it can cause the muscles around the scapula to become sore or bothersome…
Howard Luks, MD
Westchcester County, NY
Michael… When our shoulder bothers us and doesnt move properly, we tend to compensate by using our scapula muscles in a manner they are not used to. That can cause spasm in the region around your shoulder blade (scapula). There are also other reasons to have spasm in that region … and that could potentially be related to you initial injury too.
Keep us informed.
Howard Luks, MD
Westchester County, NY
Name Keisha
I fell exactly three years ago and injured my shoulder. I went straight to the emergency room for an xray, which came up negative and the doctor told me that my ligiments were stretched to the max. He prescribed something for the pain and swelling. Now three years later my shoulder is badly hurting. It hurts mostly at night or if I lift my arm above my head, however lifting small things such as a gallon of milk does not hurt. Does this sound like I have a torn rotator cuff? Thanks
Keisha… It’s impossible to say whether or not you have torn your rotator cuff, but it does *sound* like your rotator cuff is the source of your pain. Not all rotator cuff pain is because of rotator cuff tears. Tendinosis or inflammation can hurt just as much, if not more.
Time for a good exam and perhaps further imaging.
Good Luck
Howard Luks
kathy
I have a tear in rotator cuff and bone spurs one on top of rt should that is growing. I have no pain from the cuff just knot that is on top. I can move my arm up over my head, and up behind my back with no pain The dr want to do surgery on it . I would like to wait.
This is such a common question… and there is no easy answer. Do all rotator cuff tears *need* to be fixed… no. Do some tears need to be fixed, yes. Many attritional tears (where the tissue simple wears out) can be observed or watched for years. Many people are walking around with torn rotator cuff tendons and don’t even know it! There is a body of evidence showing that some (attritional) tears are simply a consequence of genetics or aging. You need to have a sit down with your surgeon or perhaps a second opinion and see why he/she is recommending surgery. Bone spurs are not a reason to have surgery…. that theory has been falling out of favor for years. Your surgeon should be able to give you a rational reason why the tear “needs” to be fixed. If it is an attritional, small tear, and you have no pain — you should be satisfied with his/her reasoning why they want to subject you to a painful procedure with a long recovery. A shared decision making process also takes into account your values, and the affect that you feel the tear is having on your quality of life. After you have heard the rationale and incorporated other shared decision making principles, then you can make a choice on how to proceed. I hope this helps.
Generally speaking… and I must add that my disclaimer must apply :-(
All full-thickness rotator cuff tears do not need to be fixed. Some will become larger with time, some will not. We can not predict which ones will become larger. Surgery to prevent progression is probably not a wise move. Small tears can heal. Although larger ones, can not. The inflammation can be due to many things around the shoulder and may or may not be related to the tear. Injecting cortisone also alters the healing environment within the shoulder… making it less likely that a repair would be successful if you chose to have surgery.
Bottom line… many full thickness “very small) tears, and even some larger ones do not need to be fixed. We treat patients and not MRIs. If PT and injections work to alleviate pain… then it is usually OK to stop there.
Teresa
is it always necessary to fix a full-thickness tear, even if it is very small?
I find it extremely difficult to understand how a very tiny (but full-thickness) tear could never heal on its own — yet that is what my ortho keeps telling me. It seems to me, that all the extreme damage caused by surgically repairing such a tear would actually be worse than letting it slowly heal.
Another comment about the pain issue — i have been told that the inflamation around my “tiny” tear is what is causing the massive amounts of muscular spasms and cramping under my shoulder blade and down the back. I had no idea the two were even related until a cortisone shot to the shoulder stopped just about everything in the upper back.