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Decoding Shoulder Pain: Differentiating Rotator Cuff Strains Vs. Tears

Shoulder pain can disrupt your daily life, making simple tasks like reaching overhead, lifting objects, sleeping, or driving, . Identifying the root cause of your shoulder pain is the first step in finding relief and appropriate treatment. 

One common cause of shoulder pain is rotator cuff injuries, which can manifest as strains or tears. In this blog post, we will delve into the intricacies of the difference between rotator cuff strains from tears, equipping you with the proper knowledge toward the right treatment option. 

What is a rotator cuff?

The rotator cuff refers to a group of four muscles located in the shoulder joint. These muscles form a cuff-like structure that envelops the head of the upper arm bone (humerus) and helps to hold it securely within the shoulder socket (glenoid). The four muscles that make up the rotator cuff are the following:

  • Supraspinatus – this muscle runs along the top of the shoulder blade and helps initiate the shoulder’s abduction (lifting the arm away from the body).
  • Infraspinatus – positioned on the backside of the shoulder blade, the infraspinatus muscle aids in external rotation (rotating the arm outward) and stabilization of the shoulder joint.
  • Teres minor – found below the infraspinatus muscle, the teres minor assists in external rotation and contributes to the shoulder’s stability.
  • Subscapularis – situated on the front side of the shoulder blade, the subscapularis muscle allows for internal rotation (rotating the arm inward) of the shoulder joint and provides stability.

The rotator cuff muscles are responsible for shoulder movement, stability, and injury prevention. However, due to the demands placed on them during shoulder movements, the rotator cuff muscles have a lot of wear and tear and can be susceptible to various types of injuries, such as strains and tears.

Injuries after 40 years old are common.  Taking care of shoulder pain from rotator cuff strains and strains can help prevent rotator cuff tears and surgery.

What is a rotator cuff strain?

Rotator cuff strains are a common cause of shoulder pain. They occur when the muscles and tendons of the rotator cuff are overstretched or torn due to repetitive motions, overuse, or sudden traumatic events. Some of the most common signs of muscle strain include:

  • Dull, aching, or sharp pain in the shoulders.
  • Tenderness and weakness
  • Mild to moderate swelling
  • Limited range of motion – like behind the back
  • Muscle spasms
  • Pain with specific movements, such as lifting or reaching
  • Pain or discomfort that may radiate to the neck, upper arm, or back.

Strains can occur from activities like lifting heavy objects, participating in sports, or even sleeping in an awkward position. 

Rotator cuff strains themselves are not typically considered dangerous, but they can cause significant discomfort, pain, and functional limitations. The severity of a rotator cuff strain can vary, ranging from mild to more severe cases. 

While mild strains may resolve with conservative treatment and self-care measures, more severe or repeated strains can lead to complications and prolonged recovery.

What is a rotator cuff tear?

Rotator cuff tears are more severe than strains and involve the actual tearing of the tendons connecting the rotator cuff muscles to the bone. 

Tears can result from degenerative changes, sudden injuries, or chronic wear and tear over time. Some of the most common symptoms  of this injury include:

  • Sharp, deep, or aching pain
  • Shoulder weakness and stiffness
  • Reduced range of motion
  • Popping or clicking sounds and grinding sensation.
  • Shoulder instability or looseness.
  • Muscle atrophy

It’s important to note that not all rotator cuff tears cause significant symptoms, and some individuals may have tears without experiencing noticeable pain or functional limitations. 

What are the different types of rotator cuff tears?

Rotator cuff tears can be classified into different types based on location, size, and severity. The main types of rotator cuff tears include:

  1. Partial thickness tear

This type of tear involves damage to the rotator cuff tendon, but it does not completely sever the tendon. It can be further classified as either articular-sided (involving the side that contacts the joint) or bursal-sided (involving the side facing the bursa).

  1. Full-thickness tear

A full-thickness tear, also known as a complete tear, involves a complete separation of the rotator cuff tendon from the bone. It can occur either at the insertion site (where the tendon attaches to the bone) or within the tendon itself.

  • Small tear: A small tear typically involves less than 1 centimeter of the tendon. It may not extend through the entire width of the tendon.
  • Medium tear: A medium tear is larger than a small tear but still involves a portion of the tendon. It may extend beyond 1 centimeter but not fully across the tendon.
  • Large tear: A large tear involves a significant portion of the tendon, typically extending across the full width of the tendon.
  • Massive Tear: A massive tear is a severe tear that involves a complete detachment of the rotator cuff tendon from the bone. It may be associated with retraction (pulling back) of the tendon and significant muscle atrophy.
  1. Acute tear

An acute tear occurs suddenly, often as a result of a traumatic event or injury. It can happen during activities such as falling on an outstretched arm or lifting a heavy object with excessive force.

  1. Degenerative tear

A degenerative tear develops gradually over time due to wear and tear on the rotator cuff tendon. It is commonly seen in individuals over 40 years old and is associated with age-related changes and repetitive shoulder use.

  1. Intra-articular tear

An intra-articular tear refers to a tear that extends into the joint space of the shoulder. It involves the portion of the tendon within the joint, potentially affecting the articulation and movement of the joint.

What is the difference between rotator cuff strains and tears?

Distinguishing between rotator cuff strains and tears can be challenging as they share some overlapping symptoms. However, certain factors can help you differentiate between the two. 

Rotator Cuff StrainRotator Cuff Tear
DefinitionOverstretching or minor tearing of the rotator cuff muscles or tendonsPartial or complete separation of the rotator cuff tendon from the bone
SeverityCan range from mild to moderateCan range from partial-thickness to full-thickness
CausesRepetitive overhead activities, trauma, overuseAging, degeneration, repetitive use, trauma
SymptomsLocalized shoulder pain and tenderness Shoulder pain, often more intense or severe and radiating. Additionally, the majority of the patients tend to experience movement difficulties.

Seeking a professional diagnosis is essential for accurate differentiation. Occupational therapists and certified hand therapists employ physical examination techniques, such as range of motion tests and strength assessments, provocative testing, to pinpoint the exact nature of the injury. 

Furthermore, imaging tests like MRI or ultrasound can provide a clearer picture of the extent of the damage and aid in helping you determine surgery needs.

Most protocols for rotator cuff injuries are to try conservative treatment such as occupational therapy and physical therapy.  Pick the right place what’s knowledgeable and gives you the time and attention to getting results is the difference between successful treatment outcomes or rushing into surgery.

What are the treatment options for rotator cuff injuries?

Once diagnosed, treatment options are tailored to the specific injury. It may involve conservative approaches for strains and mild tears, while surgical intervention may be required for severe cases.

  1. Non-surgical approaches

Non-surgical treatment options are often considered as the initial approach for rotator cuff strains and tears, especially for milder cases. These approaches aim to reduce pain, promote healing, and restore shoulder function. They may include

  • Rest

Avoiding activities that exacerbate symptoms and allowing the injured shoulder to rest is vital in the early stages of healing. This can help reduce further strain on the rotator cuff and enable the body to initiate healing.  This should only be for a few days at the most.  “Resting” too long can result in acquired frozen shoulder and making therapy longer and more difficult.

  • Physical therapy/occupational therapy 

A structured physical/occupational therapy program is often prescribed to strengthen the muscles surrounding the shoulder, improve the range of motion, and promote stability. Physical therapists or occupational therapists can guide you through specific exercises and techniques tailored to your  symptoms and stage of recovery.

  • Pain management

Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to alleviate pain and reduce inflammation. 

In some cases, corticosteroid injections may be used for short-term pain relief, although their use should be reasonable due to potential side effects.

These all have side effects that you should consider.  If you have been suffering for a while, talk to your physical/occupational therapist about what you can do to avoid taking pills and getting injections.

  • Modalities

Therapeutic modalities, such as heat or ice therapy, ultrasound, or electrical stimulation, may be utilized to provide pain relief, reduce inflammation, and enhance tissue healing.  Ask your therapist if these modalities can help you during your recovery.  If you have tried and it’s not giving you consistent relief and helping overall with your symptoms, you need to consider making changes to how you use modalities. 

  1. Surgical interventions for severe tears

Surgery may be recommended for individuals with larger, more severe rotator cuff tears or when non-surgical approaches fail to provide adequate relief.  

The specific surgical procedure will depend on factors such as tear size, location, and patient characteristics. Talk to your physical/occupational  therapist if surgery is right for you and what is the protocol and therapy journey after surgery. 

Common surgical interventions for rotator cuff tears include

  • Arthroscopic repair

This minimally invasive technique involves using a small camera (arthroscope) and specialized instruments to repair the torn tendon. It typically involves reattaching the tendon to the bone using anchors, sutures, or other fixation methods.

  • Open repair

In some cases, an open surgical approach may be necessary, especially for large or complex tears. It involves making a larger incision to directly access and repair the torn tendon.

  • Tendon transfer

In certain cases where the rotator cuff is severely damaged or irreparable, a tendon transfer procedure may be performed. This involves using a nearby tendon to replace the torn rotator cuff tendon.

  1. Rehabilitation and recovery process

Rehabilitation plays a vital role in the recovery process following both non-surgical and surgical treatments for rotator cuff strains and tears. The goals of rehabilitation include the following:

  • Pain management with ice or heat therapy
  • Restoring range of motion
  • Strengthening exercises
  • Functional training
  • Gradual return to activity
  • Lifestyle modification

Additionally, occupational therapy plays a significant role in the rehabilitation and recovery process for individuals with rotator cuff tears. 

Occupational therapists are trained healthcare professionals who specialize in helping individuals regain independence and function in their daily activities.

Where to find the best Miami occupational therapist?

Shoulder pain can significantly impact your daily life, but understanding the differences between rotator cuff strains and tears is critical to finding the appropriate treatment. 

It’s possible for you to be more active, life without pain, avoid pills, injections, and surgery. 

By differentiating between these injuries, you can seek timely medical attention and receive a tailored treatment plan from the board-certified experts of Hands-On Therapy Services.

At Hands-On Therapy, we pride ourselves on being the leading facility that provides exceptional rehabilitative therapies and services, such as:

Whether you’re recovering from a rotator cuff tear or seeking a certified hand therapist near me, we are here to provide personal support and help you get clear on what’s possible for you to get the best recovery.

Contact us by giving us a call at 786-615-9879 or requesting a Free Discovery Visit

A Discovery Visit is for someone who is not sure therapy with us can help them, wants to speak with the specialist to feel confident that therapy is the right choice for them, and is SURE they don’t want to live in pain, worry, and feeling like they can’t do certain things just because of the pain. 

** If you are an occupational therapist, physical therapist, or certified hand therapist who wants to learn and develop your skills in hand therapy, please visit Hoang Tran’s program

Hoang Tran offers both online and in-person learning events to help you develop your clinical skills.

The material contained on this site is for informational purposes only and DOES NOT CONSTITUTE THE PROVIDING OF MEDICAL ADVICE, and is not intended to be a substitute for independent professional medical judgment, advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare providers with any questions or concerns you may have regarding your health.

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