Shoulder
Rotator cuff injury
The rotator cuff is a group of four muscles and their tendons — supraspinatus, infraspinatus, teres minor and subscapularis — that hold the head of the humerus in the shallow socket of the shoulder blade and control rotation and elevation of the arm. Injury ranges from inflammation and wear of a tendon through partial tearing to a full-thickness tear, and may develop gradually with age and use or occur acutely with a fall or a sudden load.
Symptoms
Shoulder pain has several common sources, and these features help distinguish cuff problems from the others.
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Pain reaching overhead or behind the back
Dressing, reaching a high shelf or fastening a seatbelt are frequently reported. Pain through the middle of the movement arc, rather than throughout it, is typical of the cuff.
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Night pain when lying on that side
One of the more consistent features, and often the symptom that prompts people to seek assessment.
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Weakness
Difficulty holding the arm out to the side, or the arm dropping when lowered slowly, suggests a more substantial tear and is assessed promptly rather than observed.
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Symptoms referred from the neck
A proportion of shoulder pain originates in the cervical spine. Distinguishing the two is a standard part of the examination, because treating the shoulder will not help if the source is the neck.
Causes and risk factors
Most cuff problems are degenerative rather than traumatic, developing over years before they become painful.
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Age-related tendon change
Tendon quality and blood supply decline with age, and the prevalence of cuff tears rises steadily in later decades — including in people with no symptoms.
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Repetitive overhead activity
Occupations and sports involving sustained or repeated overhead use load the cuff in the position where it is most vulnerable.
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Acute injury
A fall onto an outstretched arm, or a sudden heavy lift, can tear a tendon outright — sometimes one already weakened by degenerative change.
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Shoulder mechanics
The shape of the acromion, scapular control and posture influence the space available to the tendons as the arm is raised.
Diagnosis
Examination establishes which structure is involved; imaging characterises it when that will change management.
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Physical examination
Specific tests assess each tendon’s strength and provoke the painful arc, alongside assessment of the joint, the neck and scapular movement.
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Ultrasound
Musculoskeletal ultrasound images the tendons directly and allows them to be examined dynamically, while the shoulder moves. It involves no ionising radiation.
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MRI and X-ray
MRI characterises tear size and muscle quality where surgery is being considered. X-ray does not show tendons but identifies arthritis, calcific deposits and bony anatomy.
Common questions
Does a rotator cuff tear always require surgery?
No. Many tears, including some full-thickness tears, are managed with rehabilitation. Surgery is more often indicated for acute tears in younger or highly active people and for tears causing significant weakness.
How is this different from frozen shoulder?
Frozen shoulder, or adhesive capsulitis, restricts movement in all directions including when someone else moves the arm for you. Cuff problems typically allow passive movement while active movement is painful or weak. The distinction is made on examination.
Is an MRI needed?
Not always as a first step. Ultrasound answers many questions about the tendons, and MRI is most useful when the findings would change the decision — for example when surgery is under consideration.
Can a torn tendon heal by itself?
A torn tendon does not reattach on its own, but many people become comfortable and functional without it being repaired, because the surrounding muscles compensate. Symptoms and function, rather than the imaging appearance alone, guide treatment.
General reference information, and not advice about your own case. It may not reflect the most recent guidance or what is offered on a given day — call (201) 408-5151 to check.
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Dr. Yoo Rehab Clinic welcomes new patients from across Northern New Jersey and New York City, including Englewood, Teaneck, Fort Lee, Palisades Park and Ridgefield. Call today to learn more about insurance, scheduling, and how we can help.
