Torn rotator cuffs are a frequently encountered problem identified in my office on a daily basis. Sadly, far too many patients are under the assumption that because something is torn, it must, therefore, be fixed. Luckily, many of you with torn rotator cuffs will not require surgery. Let’s dive a little deeper in the shoulder and the subject of rotator cuff tears.
The rotator cuff is four small muscles which control our shoulder stability and motion. These are small muscles which are easily overcome by repetitive stress, age-related degeneration or a traumatic injury. In order to guide you further, let’s answer the following questions.
Torn Rotator Cuffs Questions
- Why are torn rotator cuffs so common?
Normal Rotator Cuffs - What caused my torn rotator cuff?
- Do all torn rotator cuffs require surgery?
The rotator cuff is composed of tendon tissue. A tendon is a structure which connects a muscle to the bone. In the pictures to the right, the rotator cuff is the white tissue you see attaching to the ball which is the top of the arm bone.
Most of our tendons are very thick and very strong. They also have a very firm grasp of the bone they are attached to. Our bodies are very “smart”. The more we use a tendon, the stronger and thicker it gets. Similarly, the less we use it, the weaker it becomes.
Most torn rotator cuffs are not caused by an injury such as a fall. Some torn rotator cuffs are caused by trauma, and I’ll discuss that later. The vast majority of rotator cuff tears involve the tendon of the supraspinatus muscle. Because of how the shoulder works, the supraspinatus is subject to very little stress… therefore the tendon can become thin; its attachment becomes weak, and eventually, a hole develops. Many torn rotator cuffs have a degenerative origin, much like the front of your knee on your favorite pair of blue jeans. This hole is unfortunately called a tear — and many of you believe you have actually torn your rotator cuff. We refer to these common tears as “degenerative rotator cuff tears”. That implies that the tendon simply wore out.
Does all Torn Rotator Cuffs Need Surgery?
There is a lot of recent literature or scientific evidence that many torn rotator cuffs do not become larger and the majority of torn rotator cuffs will not require surgery. Contrary to the studies I just mentioned, there is literature showing that the number of torn cuffs being treated surgically has also risen dramatically. The authors speculate that our fee-for-service reimbursement system is to blame.
The majority of people with a degenerative and torn rotator cuffs can be managed quite effectively with physical therapy, injections, rest from certain overhead activities for a while and patient observation. We do recommend an annual visit to your doctor so they can assess your level of function, pain and perhaps image your rotator cuff with an Ultrasound or MRI to look to see if the tear has become larger. In patients who fail to improve with non-surgical measures, or in patients whose tear becomes much larger, then rotator cuff surgery is indicated.
I mentioned before that most torn rotator cuffs occur due to the fact that our tissues simply wears out. Another (far less common) source of a tear in your rotator cuff is trauma or an injury. Torn rotator cuffs generally require a significant injury to cause a tear. Most shoulder docs would agree. In patients with acute (recent), traumatic tears, surgery is generally indicated to repair the tear and sew it back to the bone it was torn from. PRP or Stem cells for the treatment of torn rotator cuffs is controversial at present… and is the subject of significant investigation.
Edann
I hit a basketball like a volleyball last week in gym (whoops) and my shoulder popped and instantly went numb. It has hurt since and I can’t raise it above my head without wincing. Should I be concerned?
You should be evaluated … that could mean that your shoulder dislocated, then reduced or went back in spontaneously.
Karen
Finding this article has been a godsend, thank you. I hurt my shoulder over a month ago when I was horsing around with my husband. We are very physical people and play a lot of rugby. In this case he tackled me and I turned and took it all in the shoulder. I heard a crunch and it felt weak. In the weeks since I have lost range of motion in the right, can not sleep on my right arm, get a sharp pain if I lift the arm behind my head, and get a very loud pop at other times. I am still doing yoga with some discomfort in some poses but I can lower into cobra and hold downward dog. I’m 46, mid sized, fit. But I’m worried I might need surgery. By the sounds of your article, maybe not? I’m going for an ultrasound but not for three weeks. Should I try to get in earlier? Thank you Dr!
Many potential causes of your pain and decreased motion… A good exam is where I would start. Followed by an US or MRI if needed.
2-3 weeks should be ok.
Good Luck !!!
Abel Rodriguez
I’m 20 in good physical shape and my shoulder pops out every time I move my right arm back behind me or throw a ball in a pitchers form. My injury happened throwing the old pig skin out back with my brother. I went to throw the ball for a long pass and it felt like I threw my arm out. Now it really hurt and I felt my shoulder pop out of place. I was able to pop it back in and it was sore for about 2 days. A couple of weeks after that I was getting on to a trailer and as I was pulling my self in to the trailer I had my arm a little bit behind me as I was getting on and it my shoulder popped out again. It hurt again and I was in pain like before. I went through the same procedure. It happens alot when I use my right arm for physical activity. One time it happened when I was putting on a sweater. It been going like this for over 3 years. After like 2 days my arm is better everytime it pops out. I am wondering if this is normal or can it lead to something worse. I do have a lot of muscle and lift weights regularly. So I’m in really good physical shape.
definitely not normal … time to see a good Orthopedic Sports Doc with an interest in shoulder injuries
Claude
I was lifting a 50 lb bag of cement into the back of a pickup truck. the tailgate would not come down. In lifting it over the tailgate a loud pop like a bone breaking. I cant raise my left arm but my wife raise it up and i had no pain. I am in sever amount of pain. I go to a pain Dr. and the med im on will help for a short amount of time. I am thinking about going to the ER.
I would see an orthopedist
Andrew
Hi- I’m 28 years old and in good physical shape. Last week I went surfing for about 2 hours, then I drove home. On the way home my arms and shoulders felt really tired, but I went and played tennis that afternoon for about 2 hours anyways. By the time I finished playing tennis my right shoulder (the one I serve with in tennis) was really hurting. Now days later it is still hurting and I cant really sleep on it. Should I get it checked out or just rest it for a few more days? Thanks in advance for any help.
I would see your primary care doc or an orthopedist.
Phil
Hi – I’m 60 years old and I am pretty good shape. Crossfit and weightlifting for 3+ years now. I mount and balance race tires for a living. Just this past weekend I bent over and was pulling up on a tire extremely hard, I felt/heard a pop and then a burning sensation in my right shoulder (anterior deltoid). Now if I externally rotate my shoulder while I’m bent over and pull at the same time I will get the popping and burn. It actually makes me lose all my strength for a few seconds. I can lift objects above my waist as long as I keep my shoulder rigid and not externally rotate by forearm/bicep. I also have no problem pushing objects above my waist or above my head. Help!
Sorry Phil :-( You have likely strained or torn your rotator cuff or biceps. If your pain doesn’t improve slowly over the next few weeks I would see a shoulder doc for a solid exam and discussion.
Cameron
Hi i recently hurt my shoulder snowboarding and have noticed that my shoulder clicks and pops when i raise it as if i was going to throw a ball. I went to play tennis and i noticed i couldn’t serve as there was a lot of pain. Do you think I’ve damaged my rotator cuff?
Many possibilities… a strain with inflammation, labral tear, rotator cuff injury, etc… A physical examination will help guide your treatment.
Travis
I am a boxer aged 20 and since my last sparring session, I’ve felt some clicking in my right shoulder and it pains ever so slightly when I lift my arm. Its been a week nearly and today I also noticed that if I do bicep curls (without weights), my elbow clicks too, though there is no pain there yet. Could this be a problem on the horizon? Please advise..
unlikely Travis… but if it persists an Xray might be beneficial
Joshua
Hey there Dr Luks,
I’m 22 and woke up this morning with an excruciating pain in my right shoulder. When I was about 17 I was throwing a ball and felt a burning sensation run down my arm. After that I was unable to throw a ball without feeling pain for almost a year. Slowly it got better. Off and and on since then I would feel a twang of pain here or there. Wouldn’t really be able to do push-ups without feeling a dull pain start to build. But for the most part very functional. I never loss any range of motion or felt any clicking or popping. Anyhow. Yesterday I started jogging again. Ran a couple of miles. Came home felt fine. Went to bed and this morning I woke up a lot earlier because I couldn’t sleep. Shoulder pain was at least an 8/10. It hurts mainly when it’s not being used. I make a throwing motion and it hurts little to none. But resting on my side it just burns. I’m in relatively good shape. Pretty thick guy. I weigh 245 and am 6′. Very muscular. Any ideas or thoughts would be appreciated. Thanks.
GIovanni
I am a football player in my mid teens and i enjoi lifting heavy weight but i injured my rotating cuff benching and am now in therepy. Can this injury affect me after it has healed. It only hurts using strength above my head or extended out in front of me. I am impatient and dont know how long it will take to heal. The pain is only a 1 out of 10 with no weight. I have not been working out other than agilitys and crunches. i ice my shoulder 4 to 6 times a day and exercise with a large rubber band. Is there an estimated time you think ill be out for?
Rotator cuff injuries are rare at your age and usually resolve fairly quickly. It is important to be sure that you do not have a subtle form of instability.
Amber
I was recently told I have tendonitis. I was at work and my shoulder popped and went numb. This pop was louder and 3 times more painful then the rest. Also I am unable to move my arm. What could be wrong with it?
Tough to say without examining you. But possible causes of these types of complaints include the arm dislocating. Time to see your doctor again.
Good Luck
Ron
I simply fell asleep on my couch awakened the next morning and now I have tremendous pain from my rotator cuff upon certain movement. Could it simply be a strain, does it have to get better on its own, is there something I can do to accelerate the improvement?
It does sound like the rotator cuff might be bothering you. This is not an uncommon story. If your pain persists, see your doctor. Therapy, etc can be very beneficial in improving the pain from rotator cuff issues.
Shane Evans
Dr. Luks,
Thank you for taking the time to put this article together. I had an injury about 3 weeks ago, and saw my Dr. this week. The shoulder is a mystery to many of us and your during and post procedure photos certainly help with understanding what is facing me.
Mary
I recently tripped and fell solely on my shoulder. I have been in pain for 4 days an my shoulder pops when I use my arm. It is painful to move it and to sleep. Do I need to see a doctor?
Yes please
Jody
I’ve hurt my shoulder years ago (foolish jump off of a bridge in my 20’s) Now in my mid 40’s I slept slumped over on my elbow on the couch and woke up in brutal pain. It’s been months with little relief and now after I wore a homemade sling for 2 days, it’s unbearable. I can’t turn my hand upward and move it left or right without it clicking and locking up with a ton of very sharp pain. I made everything much worse after tying my arm to my torso and wearing a sling for two days and nights. I can’t use my arm if it’s bent at all. Straight down hanging at my side is fine, bent at the elbow and all movement is crunchy awful pain… any Ideas?
Yes .. please see an Orthopedist
anthony
Hi I’m 38 years old I had rotator cuff surgery last July 2013. I was doing fine until almost 1 year from surgery I retore it, some how and I don’t know how. Anyway I had an arthogram done and it’s showing 2 tears. The first is in the supraspinatus with 1.3cm retraction and the other is in the infrastr with .07 cm retraction. Iv been to 3 orthopedic specialist who only do sshoulders and they all say I think you should have this done again . What do you think will the second time work
Hi Anthony… The are occasions where a second repair can work. But the results of revision repairs are not as good as those of a primary repair.
Some of us might put a patch or other material on top of a revision repair to try and help it heal better… but we need more evidence to know whether or not that actually improves the overall results.
Good Luck to you.
Howard Luks
Anthony
I have lifted weights 6 times a week for about 6 six years. Approximately 2.5 years ago I believe I tore my left rotator cuff while at the gym and I was unable to workout and could hardly lift my shoulder for nearly 6 months. After it healed and I started working out again, I noticed my left side was weaker, and when I move it in a circular motion it makes a loud pop as opposed to my right which moves fluidly with no popping sound. I never saw a doctor for the injury, and my question is at this point is there anything that could still be done for it, or is it too late? It doesn’t cause me pain per se, but it certainly does not have the same range of motion as my good shoulder and seeing as I am in my early twenties and would like to be able to workout for many years to come, I want to do anything I can for it. Thank you.
Sounds like you should see a Shoulder Doc to examine you and determine what the next step (if necessary) is.
ryan
I was performing pushups and after I was done it started to hurt and pop a little, should I be concerned?
Time will tell… many times these issues simmer down, sometimes they persist.
Good Luck
Jim Champion
I am 67 and lift weights regularly at the gym….I often have popping in the shoulder but little pain ….I am in pretty good shape 5′ 11″ and weigh 188 lbs. Should I be concerned?
The vast majority of popping/snapping in a 60 somethings shoulder is not unusual or abnormal, per se.