The rotator cuff is a complex of four muscles and their tendons that surround the shoulder joint, connecting the upper arm bone (humerus) to the shoulder blade (scapula). This group provides stability to the ball-and-socket joint and the ability to lift and rotate the arm. A tear compromises the shoulder’s ability to move smoothly and maintain its secure position. The injury manifests in two distinct ways: suddenly (acute) or slowly (degenerative).
Sudden, Sharp Pain: Acute Tear Symptoms
A rotator cuff tear resulting from a single traumatic event, such as a fall onto an outstretched arm or a forceful, jerking lift, is known as an acute tear. The feeling is often immediate and unmistakable, starting with a sudden, sharp, and intense pain in the shoulder area. Many people report a distinct sensation of something ripping or snapping inside their shoulder at the moment of injury.
The immediate pain is typically accompanied by a significant and instant loss of strength. You may find you are suddenly unable to lift the arm away from the side or overhead, with the arm feeling heavy and unresponsive. This severe weakness, where the arm essentially “gives out,” is a hallmark sign that a major tendon has been compromised.
The Persistent Ache: Degenerative Tear Symptoms
The more common type of injury is a degenerative tear, which develops slowly due to chronic wear and tear over many months or years. Unlike the sudden trauma of an acute tear, the symptoms of a degenerative tear often begin subtly as a dull, deep ache felt inside the shoulder. This pain is not always constant at first but tends to worsen when using the arm for specific motions.
Functional limitations are a prominent feature of a degenerative tear, specifically when performing actions that require rotation or lifting the arm overhead. Simple daily tasks like combing hair, reaching into a back pocket, or fastening a bra become difficult or painful because the damaged tendon can no longer properly control the joint. The weakness may cause a noticeable struggle when trying to lift objects that were previously easy to manage.
A particularly disruptive symptom is “night pain,” which is often one of the main reasons people seek medical help. The pain frequently intensifies at night, making it difficult to find a comfortable sleeping position, especially when lying on the affected side. This chronic discomfort and the associated weakness can slowly limit mobility and overall arm function over time.
Why Rotator Cuff Tears Occur
Acute tears result from a single traumatic injury, such as a rapid, forceful lift of a heavy object or bracing oneself during a fall. This type of tear often occurs in younger individuals or those with otherwise healthy tendons.
Degenerative tears are much more common and are caused by a gradual breakdown of tendon tissue over time, often beginning after the age of 40. Several factors contribute to this process:
- Repetitive stress from activities like swimming, tennis, or construction work can fray the tendons.
- A reduced blood supply to the tendons as a person ages impairs the body’s natural ability to repair minor damage.
- Bone spurs can develop on the acromion, the bone on top of the shoulder, which physically rub against and wear down the rotator cuff tendons.
Next Steps: When to Consult a Doctor
While minor shoulder aches may resolve with rest, certain signs indicate the need for a professional medical evaluation. If you experience a complete inability to lift your arm following an injury, or if severe weakness suddenly develops, you should seek prompt medical advice. If the shoulder pain persists for more than a week despite using rest and over-the-counter pain relief, a doctor’s visit is warranted.
It is also important to consult a physician if the pain is severe enough to consistently disrupt your sleep or if the pain limits your ability to perform routine daily activities. A proper diagnosis is made through a physical examination and imaging tests, such as an MRI or ultrasound, to determine the extent of the tear. These steps are necessary to rule out other possible conditions that can cause similar shoulder pain.