The 4 Signs of a Torn Rotator Cuff

shoulder pain examination
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Rotator cuff tears are a common cause of shoulder pain, but certainly not the only cause of a painful shoulder. Determining if a rotator cuff tear is the cause of you pain depends on the symptoms and findings of your condition. Your doctor will look for some of the following signs to make the determination if the diagnosis of a rotator cuff tear is the cause of your shoulder pain symptoms. If you want to try to find out if your pain may be caused by a torn rotator cuff, read through these signs of this injury.

Pain

Pain from a rotator cuff tear is usually located over the outside of the shoulder and upper arm. Pain while performing overhead activities (with the arm above head height) and pain at night are also common in individuals with a rotator cuff tear. When the rotator cuff tear is more severe, the pain may awaken patients from sleep.

It is not uncommon for the pain of a torn rotator cuff to be felt further down the arm from the shoulder. Many people think they have a problem with the arm muscle or bone, when in actuality their symptoms are coming from the rotator cuff and shoulder joint. The reason the pain is felt further down the arm has to do with the location of the nerves that pass by the deeper parts of the shoulder. 

Decreased Strength

Strength of the rotator cuff tendons can be tested by your doctor. By isolating each of the tendons of the rotator cuff with special tests, your doctor can determine the extent of the tear.

Significant rotator cuff tears may affect a patient's ability to raise up their arm over their head. Inability to hold the arm directly out from the body is also a sign of a rotator cuff tear.

Some of these tests can be performed on your own:

Empty Can Test:  The empty can test is used to assess the status of a specific rotator cuff muscle called the supraspinatus on the upper part of your shoulder.

It is a simple test to perform, and the motion mimics that of dumping out a soda can.

  • Sit or stand comfortably with a friend present.
  • Lift your painful arm out the the side so it is parallel to the floor.
  • Bring your arm forward about 30 to 45 degrees.
  • Turn your hand over so your thumb is pointing towards the floor (as if you were trying to empty a can of soda).
  • Have your friend gently push your arm down.

If pain or weakness prevents you from maintaining your arm in the "empty can" position, you may have a supraspinatus tear. If so, check in with your doctor to confirm the diagnosis.

Lift Off Test: The lift off test is a shoulder test to determine if you have a tear in a specific rotator cuff muscle called the subscapularis. This muscle is located on the underside of your shoulder blade and is responsible for rotating your shoulder inward. To perform the lift off test:

  • Stand up and place the back of your hand on the small of your back.
  • The palm of your hand should be facing away from your back.
  • Attempt to lift your hand away from your body.

If you are unable to lift your hand away from your low back, it is suspected that a subscapularis rotator cuff injury may be present.

Resistance Testing: One simple way of determining if a rotator cuff tear is possibly causing your shoulder pain is to perform manual strength testing of your rotator cuff muscles.

To do this, follow a simple procedure:

  • Sit comfortably in a chair.
  • Bend your elbow 90 degrees and keep your elbow tucked into your side.
  • Have someone push your hand in towards your belly.
  • If you are unable to hold this position and feel pain, you may have a rotator cuff tear.

Inability to Perform Normal Tasks

Patients with a rotator cuff tear often complain of difficulty performing activities such as combing their hair, clasping a bra behind their back, reaching behind their back, or sleeping on the affected shoulder. Be sure to tell your doctor about specific activities are limited by your shoulder pain.

Abnormal Test Results

If a rotator cuff tear is suspected, a test is usually used to determine if there is a tear. The test most commonly used to diagnose a rotator cuff tear is an MRI, but this is not the only way to diagnose a rotator cuff tear. The MRI is helpful because it can show both complete rotator cuff tears and partial rotator cuff tears. The MRI can also show evidence of shoulder bursitis and other common shoulder problems. Other tests that may be used to diagnose a rotator cuff tear include an arthrogram and an ultrasound.

I Think I Have a Tear, Now What?

If you think you have a rotator cuff tear, it's time to see your orthopedic surgeon to confirm your suspected diagnosis and to determine a treatment plan.  The good news is, not every rotator cuff tear needs surgery.  However, when surgery is the best treatment, it's often better to proceed sooner rather than later as the rotator cuff muscle can weaken (atrophy) and retract (pull back) over time.  This can make repair less successful or even impossible, therefore it's good to discuss your treatment options with your orthopedic surgeon as soon as possible.

For those patients who choose nonsurgical treatment options, there are a number of ways to find relief of the shoulder pain caused by the rotator cuff tear.  Often with physical therapy and a proper exercise program, patients can improve the function of their shoulder joint to prevent pain that comes from a torn tendon of the rotator cuff.

Sources:

Omid R and Lee B. Tendon Transfers for Irreparable Rotator Cuff Tears. J Am Acad Orthop Surg August 2013; 21:492-501.

Schmidt CC, Jarrett CD, Brown BT. Management of Rotator Cuff TearsThe Journal of Hand Surgery. 2015;40(2):399-408. doi:10.1016/j.jhsa.2014.06.122.

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