The rotator cuff is a group of four muscles and their tendons that surround the shoulder joint, connecting the upper arm bone (humerus) to the shoulder blade (scapula). This cuff stabilizes the shoulder’s ball-and-socket joint, which is inherently unstable due to its high mobility, and facilitates arm rotation and lifting movements. A tear in one of these tendons—most commonly the supraspinatus—can significantly impair function and cause pain. This guide provides information on recognizing symptoms that may suggest a rotator cuff injury, but it is not a substitute for a professional medical diagnosis.
Identifying the Characteristic Pain and Discomfort
The experience of a rotator cuff tear varies significantly depending on whether the injury resulted from acute trauma or chronic degeneration. An acute tear is typically caused by a sudden event, such as a fall or lifting a heavy object with a jerking motion. This usually results in intense, immediate pain, a feeling of snapping or popping, and significant weakness in the affected arm.
In contrast, a degenerative or chronic tear develops slowly over time due to repeated wear and tear, often beginning as mild discomfort that gradually worsens. The pain from both types of tears is most commonly felt deep within the shoulder or on the side of the arm, often traveling down the arm but stopping above the elbow. Pain extending to the hand or fingers may suggest a pinched nerve in the neck rather than an isolated rotator cuff issue.
Specific activities consistently worsen the pain, especially overhead movements like reaching for a high shelf or reaching behind the back. A common symptom is night pain, where lying on the affected shoulder becomes difficult or impossible, often waking the individual from sleep. Individuals may also report a grinding, clicking, or crackling sensation, known as crepitus, when moving the shoulder.
Performing At-Home Functional Tests
Self-assessment involves gently testing the shoulder’s strength and range of motion, focusing on the four rotator cuff muscles: supraspinatus, infraspinatus, teres minor, and subscapularis. These simple movements should be performed slowly and stopped immediately if they cause sharp or severe pain. Comparing the strength and range of motion in the injured shoulder to the unaffected side is the most helpful technique.
A simplified Drop Arm Test assesses the integrity of the supraspinatus tendon, which initiates arm abduction (movement away from the body). To perform this, raise the arm out to the side to shoulder height (about 90 degrees), and then attempt to lower it back down slowly and with control. An inability to lower the arm smoothly, or if the arm drops uncontrollably from the 90-degree position, suggests significant weakness or a potential tear.
To check the subscapularis, which primarily handles internal rotation, a modified Lift-Off Test can be used. Place the back of the hand on the small of the back, and then attempt to lift the hand away from the back without leaning the elbow forward. Significant pain or the inability to lift the hand away suggests a problem with the subscapularis.
The infraspinatus and teres minor, the primary external rotators of the arm, can be checked with a gentle Resistance Check. Hold the elbow tight against the side, bend it to a 90-degree angle, and then gently push the forearm outward against the resistance of a wall or fixed object. A sudden difference in strength or immediate pain compared to the opposite arm indicates potential dysfunction in these external rotators.
When Self-Assessment Ends and Professional Care Begins
While at-home tests can suggest a possible rotator cuff issue, they cannot provide a definitive diagnosis or determine the extent of a tear. Symptoms like pain with overhead lifting or reaching behind the back can also be caused by less severe conditions, such as shoulder bursitis or tendonitis, where soft tissues are inflamed but not torn. The key difference often involves persistent, pronounced weakness or the outright inability to lift the arm, which is more characteristic of a tear.
Seeking medical attention is necessary if the pain persists for more than a week despite rest and over-the-counter medication, or if the pain limits daily activities. Urgent care is warranted for symptoms following a traumatic fall, such as immediate, severe pain and sudden loss of function. Early diagnosis is important because untreated tears can enlarge over time, leading to chronic pain and worsening weakness.
A physician, often an orthopedic specialist, will perform a physical examination and order diagnostic imaging to confirm the injury. X-rays can rule out bone issues, while an ultrasound or Magnetic Resonance Imaging (MRI) scan is needed to visualize the soft tissues and confirm the presence and size of a tear. This professional evaluation is mandatory to accurately determine if the tear is partial or full-thickness and to establish the correct treatment plan, which may include physical therapy or surgery.