Warning Signs & the Healing Process

A rotator cuff tear is marked by damage to one (or more) of the four tendons that stabilize the shoulder joint. Warning signs of a torn rotator cuff are typically felt in the shoulder area. Both partial rotator cuff tears and complete, full-thickness rotator cuff tears (FTRCTs) can make arm movements difficult and cause sharp pain or a dull ache in the shoulder that worsens at night.

Rotator cuff tears are common. They can be caused by everyday wear and tear, a single traumatic blow, or develop gradually over time due to repetitive overhead motions. Age increases risk. Nonsurgical treatments can aid in healing rotator cuff injuries. Serious tears may require rotator cuff surgery. Depending on severity, the healing process can take several weeks or months.

What Does a Torn Rotator Cuff Feel Like?

Not every rotator cuff tear causes pain. About 2 out of 3 people with a partial rotator cuff tear are asymptomatic and may not even know they have a rotator cuff injury. Only one-third of tears cause pain or other symptoms.

If a rotator cuff tear does cause warning signs, they will include:

• Crackling or popping sounds (crepitus) during arm movements
• Discomfort during sleep, especially when lying on the affected side
• Difficulty raising or swiveling the arm without experiencing discomfort
• Dull ache in the shoulder joint that gets worse at night
• Limited range of motion, especially when reaching up or rotating the arm
• Rotator cuff pain that’s felt in the shoulder area or upper arm
• Sharp, stabbing sensations when lifting or moving the affected arm, particularly overhead
• Shoulder pain that intensifies with repetitive arm activities or reaching motions
• Symptoms that worsen gradually over time, causing more intense shoulder pain
• Weakness in the arm, making everyday tasks like lifting objects or fastening a seat belt difficult

Can It Heal on Its Own?

Yes, a rotator cuff tear can heal on its own. With proper treatment, partial tears, also known as partial-thickness rotator cuff tears (PTRCTs), can heal in a few weeks to several months.

More severe tears may require surgery. The initial healing after surgery lasts about three to six months, but a full recovery could take up to a year. On average, about 50% of functional recovery can be expected three months after arthroscopic surgery to repair a torn rotator cuff.

What Happens If It Goes Untreated?

If it goes untreated, a smaller rotator cuff tear can grow larger, causing symptoms like:

• Decreased mobility
• Further degeneration of the shoulder joint
• Increased pain
• Weakness, sometimes debilitating

Over time, an untreated tear could lead to permanent damage and loss of function, making almost any arm movements involving the affected shoulder practically impossible. 

Nonsurgical Treatments

Below is a list of nonsurgical treatments for a torn rotator cuff:

Severe Injuries May Require Surgery

Severe rotator cuff injuries, such as full-thickness tears, often require surgery because the supraspinatus tendon (or one of the other rotator cuff tendons) becomes detached from the humerus (upper arm bone) bone’s head and can’t heal itself without surgical help. The supraspinatus tendon is the most common to tear, but any of the four tendons may tear. If rotator cuff muscles and tendons are severely damaged, surgery is typically needed to promote tendon-to-bone healing and restore optimal shoulder function.

What to Expect from Surgery and Recovery Time

After rotator cuff surgery, the healing process typically follows a predictable timeline. In the first few weeks, you can expect to wear a shoulder sling that limits rotator cuff movement. At around three months, you should see improvements in your ability to perform daily tasks involving the shoulder joint, but full recovery can take up to 12 months. 

It’s important to avoid heavy lifting or overhead movements until a healthcare provider or physical therapist gives you the green light. Doing too much too soon slows recovery time. Adhering to your post-op rehabilitation plan and having patience are essential parts of a successful healing process.

Causes and Risk Factors

Various lifestyle choices, workplace conditions, sports activities, and inevitable factors like aging are associated with an increased risk of rotator cuff tears, including the following:

• Acute trauma (e.g., falling on an outstretched arm, collision sports, car accidents)
• Bad posture
• Family history
• Getting older
• Heavy lifting with improper form
• Repetitive overhead movements (e.g., serving tennis balls, painting ceilings, construction work)
• Smoking

Can You Reduce Your Risk?

Preventing a rotator cuff tear isn’t always possible, especially if aging or genetics cause it. However, there are several measures you can take to reduce your risk, such as:

• Maintain good posture: Avoid slouching whenever possible; bad posture causes shoulder impingement.
• Quit smoking: Tobacco cessation improves tendon health and reduces your risk of rotator cuff tears.
• Strengthen your shoulder muscles: Strength-training exercises targeting the rotator cuff muscles can fortify shoulder stability.
• Take breaks: If your job or hobbies involve lots of repetitive overhead movements, take breaks and try to avoid overuse whenever possible.
• Use proper lifting techniques: Whether lifting weights or doing household chores, make sure you’re using the correct form when lifting above your head to avoid unnecessary shoulder strain.
• Warm up and stretch: Warming up and stretching your shoulder muscles before working out can help prevent rotator cuff injuries.

Diagnosis and Tests

Rotator cuff tears are diagnosed with a physical exam and imaging tests such as X-rays, ultrasound, or magnetic resonance imaging scan (MRI). These two simple tests may be performed during a clinical examination that you can also do at home with the help of a friend: 

• Drop arm test: Ask someone to passively lift your arm to the side at a 90-degree angle, parallel to the floor, and then let go. If you cannot lower your arm in a smooth and controlled manner after it’s been dropped without experiencing pain, it could indicate a rotator cuff tear.
• Empty can test: Sitting or standing, raise your arms to 90 degrees while rotating your thumbs towards the floor as if you’re emptying a can. While holding this position, have someone apply downward pressure on your forearms. If your affected shoulder is weaker or more painful than the unaffected one, it could indicate a rotator cuff tear.  

When to See a Healthcare Provider

If you have shoulder pain that doesn’t improve after a few days of rest, it’s probably time to see a healthcare provider. Pay attention to warning signs like sharp pain during daily tasks such as reaching for something on a high shelf, putting on a coat, or grabbing your seat belt.

Also, if shoulder pain worsens at night or you cannot lift your arm without discomfort, don’t put off getting it checked out. If treatment is delayed, smaller rotator cuff tears can become larger and harder to heal.

Summary

A rotator cuff tear happens when one of the tendons in your shoulder gets hurt. Warning signs include shoulder pain and trouble lifting your arm or reaching overhead. Healing can take time. Small tears usually get better with nonsurgical treatments, but bigger ones may require surgery. Avoid heavy lifting and other arm movements that might aggravate the tear to help it heal properly.