Pain in the shoulder may occur for many reasons. Although not the most common reason, rotator cuff tears can cause pain.
The rotator cuff is made up of four muscles and their tendons. These allow you to move your arm away from your body.
A tear in this group of muscles is commonly accompanied by pain when in motion and also at night. Weakness of the arm may occur if the condition is allowed to deteriorate. If the tear becomes very large, the muscles around the shoulder may waste away to the point where you can see it.
How does the shoulder work and why does the rotator cuff tear?
Because of the complexity of muscles and ligaments and the lack of bony constraints, the shoulder is capable of extensive motion.
The shoulder is a large ball-and-socket joint. It is made up of bones, tendons, muscles and ligaments which hold the shoulder in place but also allow movement. Bones of the shoulder joint include: the clavicle (collar bone), scapula (shoulder blade), and humerus (arm bone). The clavicle attaches the shoulder to the sternum and holds it out away from the body. (Fig. 1)
The clavicle connects with the shoulder blade at the acromioclavicular joint (A.C. joint or the acromion). The rounded head of the humerus, or arm bone, rests against the socket in the shoulder blade.
The rotator cuff is the group of muscles and tendons which stabilizes the shoulder and holds the arm bone within its shallow socket (the glenoid). This group of muscles includes: the teres minor, supraspinatus, infraspinatus, and subscapularis.
Most often, the tear involves the supraspinatus tendon. In these cases, the tear occurs when the tendon rubs over a bone spur during a long period of time.
When should I call my doctor?
Call your doctor when you feel continuous weakness and pain in your shoulder. The most common symptom of a torn rotator cuff is pain, particularly at night. This night pain may be severe enough to keep you from sleeping. Call your doctor if you are experiencing this type of discomfort.
How is a torn rotator cuff diagnosed?
Your doctor may use some of these tests to diagnose a torn rotator cuff:
- A physical examination of your shoulder. Your shoulder will be checked for sensitivity to pain, limitation of motion, and soreness or a popping sound that occurs when you move your arm in any direction.
- An X-ray of your shoulder.
- An MRI (Magnetic Resonance Imaging scan) and examination of your shoulder. An MRI uses magnets and radio waves to provide detailed images of internal tissues.
How is a torn rotator cuff treated?
Because complete rotator cuff tears cannot heal by themselves, surgery is sometimes required if the pain persists despite therapy. The surgery repairs the torn muscle tendon, and also removes the bone spur which caused the muscle to tear.
The goal of surgical repair is to relieve pain and restore function to your shoulder. You will probably be required to use a sling for at least six weeks after surgery. This is for comfort and to help protect the muscles from unnecessary or damaging movement.
You may not have significant pain relief or an increase in motion for several months following rotator cuff surgery. The healing process, coupled with physical therapy, takes an extended period of time.
Physical therapy is essential to the success of any shoulder operation. Your doctor will prescribe and explain exercises to aid in your recovery.
What happens after your rotator cuff surgery?
Your first postoperative clinic appointment will be approximately 10 to 14 days after discharge. At this time, the stitches will be removed from your shoulder. Because stitches will still be in place at the time of discharge, please keep the incision clean and dry and do not get your incision wet. Once your stitches have been removed, you may shower or bathe normally. During your hospital stay and after your discharge, you may apply a cooling device and take pain medication, if necessary, 1/2 hour before you exercise. Once the stitches have been removed, a hot shower is also helpful, prior to exercise. This aids in relaxation and helps to decrease pain.
After the initial postoperative appointment, your doctor will determine how many more appointments you will need. Driving is not recommended for the first month after rotator cuff surgery.
What do I need to know about physical therapy?
We stress the importance of physical therapy. Consider your physical therapist like a piano teacher who gives you instructions. You may do very well during your session with the teacher, but you must still go home and practice to improve.
It is important to realize that motion and pain are directly related. As motion improves from exercising, the pain will diminish. It is very common to have continued discomfort for four to six weeks after the operation, however, this usually only indicates more exercises are needed.
NOTE: Active elevation, or lifting your arm to the side, will damage the repair and may be very painful. Do not lift your shoulder this way (illustration to the right).
Your exercises will be divided into phases. Do not progress or go on to the following phase unless instructed by your doctor. By doing so, you may harm your shoulder.
Ordinarily, passive stretching exercises are done for several weeks after surgery. Strengthening exercises may begin 6 to 12 weeks after your surgery, as instructed by your doctor. This allows the muscles to heal well, repairing the tear entirely. As your motion slowly improves, you will be given different exercises.
Exercises are usually most difficult in the morning. You will probably feel stiff when you wake. This is normal. As you exercise, your shoulder will gradually loosen up and the stiff feeling will go away.
Once the rotator cuff has healed, be good to your shoulder by avoiding extra and unnecessary physical stress. Some ways to do this:
- Always carry heavy objects close to your body.
- Use good body mechanics, standing straight with your shoulders back.
- In bed avoid undue pressure on the affected shoulder by lying on your other side.
- American Academy of Orthopaedic Surgeons - Rotator Cuff Tears: Surgical Treatment Options
- National Institutes of Health: Rotator Cuff Injuries
- National Institute of Arthritis and Musculoskeletal and Skin Diseases: Shoulder Problems
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 7/13/2016...#8291