Shoulder tears are common, causing discomfort and limiting daily activities. Resulting from trauma or wear and tear, effective treatment restores function, reduces pain, and prevents complications. The approach varies by tear type, severity, and patient factors.
Understanding Different Shoulder Tears and Their Causes
A “torn shoulder” refers to damage to soft tissues in the shoulder joint: muscles, tendons, ligaments, or cartilage. Rotator cuff and labral tears are common types. The rotator cuff’s four muscles and tendons stabilize the shoulder, enabling arm movements. Tears can be partial (some fibers damaged) or full-thickness (complete tendon separation).
Rotator cuff tears result from acute injuries (e.g., falling on outstretched hand) or gradual wear and tear from aging and repetitive overhead motions. Individuals over 40, athletes, and those with frequent overhead occupations (e.g., painters, carpenters) are at higher risk for degenerative tears.
Labral tears involve the labrum, a cartilage ring that deepens the shoulder socket and stabilizes the joint. They result from acute trauma (e.g., dislocation) or repetitive overuse, especially in throwing sports. Age-related degenerative changes and underlying structural issues also contribute, increasing susceptibility to tearing.
Accurate Diagnosis of a Shoulder Tear
Diagnosis begins with a physical exam and medical history. The professional assesses tenderness, range of motion, and muscle strength via specific tests. These identify affected structures, assessing weakness or pain. For example, the “drop arm test” indicates a full-thickness rotator cuff tear if the arm cannot be slowly lowered from an abducted position.
Imaging confirms diagnosis and visualizes soft tissues. X-rays rule out bone spurs, fractures, or arthritis, but not soft tissue tears. MRI visualizes tendons and cartilage, determining tear size and type, and shows tendon retraction or tear patterns, influencing treatment.
Ultrasound provides real-time soft tissue images, allowing dynamic assessment of shoulder tendons and muscles. For labral tears, a CT-arthrogram (dye injection before CT scan) is useful, though MRI is often preferred. Accurate diagnosis is key for effective treatment.
Non-Surgical Treatment Pathways
Non-surgical approaches are often the first treatment for shoulder tears, especially for less severe injuries or when surgery is unsuitable. Key elements include rest, activity modification (avoiding aggravating movements), and temporary sling use. Ice reduces inflammation and pain. Once swelling subsides, heat therapy helps relax muscles, increase blood flow, and alleviate chronic stiffness.
Pain management includes over-the-counter NSAIDs (e.g., ibuprofen, naproxen) to reduce pain and swelling. For severe pain, stronger pain relievers might be prescribed short-term. Physical therapy is key, focusing on exercises to restore range of motion, strengthen muscles, and improve stability. A therapist also teaches alternative movement patterns to reduce stress.
Injections are also part of non-surgical plans, especially if pain persists. Corticosteroid injections, often ultrasound-guided, deliver anti-inflammatory medication directly to the affected area, reducing swelling and pain. These provide temporary relief (weeks to months), facilitating physical therapy. Platelet-rich plasma (PRP) injections use the patient’s own blood components to promote healing, though research is ongoing.
Surgical Treatment Options
Surgery is considered for shoulder tears when non-surgical methods fail, for severe tears, or specific injury types. Persistent pain and weakness after conservative treatment, or a full-thickness tear impairing function, indicate surgery. Acute tears from sudden injury, especially in younger, active individuals, also warrant surgical repair to prevent muscle atrophy and tendon retraction.
Arthroscopic repair is minimally invasive: a surgeon makes small incisions to insert a camera and instruments. This allows visualization of the joint on a monitor to perform repairs (e.g., reattaching torn tendons, removing damaged tissue) with less trauma. Arthroscopy is used for rotator cuff and labral repairs, and to address inflamed tissue or loose cartilage.
For complex tears with limited arthroscopic access, open repair may be necessary, involving a larger incision to access and repair the damaged area. If direct tendon repair is not feasible due to poor tissue quality or extensive damage, tendon transfer (using a tendon from another location) restores function. Surgical technique depends on tear size, location, tissue quality, and patient health/activity level.
Post-Treatment Recovery and Rehabilitation
Recovery from shoulder tear treatment (surgical or non-surgical) requires structured rehabilitation to regain strength and mobility. Immediately after surgery, initial immobilization with a sling is necessary for weeks to protect healing tissues and allow tendon reattachment.
Physical therapy begins early, sometimes with passive movements where a therapist moves the arm to improve mobility without active muscle engagement. As healing progresses, the program advances to active exercises, increasing resistance to strengthen the rotator cuff and surrounding muscles. These exercises restore flexibility, improve range of motion, and rebuild shoulder stability.
Pain management during recovery involves prescribed medications and continued use of ice or heat therapy to control swelling and discomfort. Timeline for returning to normal activities or sports varies by tear severity, treatment type, and rehabilitation adherence. Most individuals require several months of physical therapy for a gradual return to strenuous activities. Athletes might need 4-12 months of sport-specific rehabilitation to regain strength and reduce re-injury risk.