Rotator Cuff Tears

What Is Considered A Rotator Cuff Tear?

rotator cuff tear

Typically a "rotator cuff tear" means that one or more of the rotator cuff TENDONS was torn. Recall that the rotator cuff is comprised of four MUSCLES.


Examples of Torn Rotator Cuffs:
The arrow in figure A points to a rotator cuff TENDON. Figures B and C represent partial tears in that tendon. These will usually heal without surgery, though much adhesion will build up when it heals. Figures D and E represent complete Tears. Figure D is a recent tear, figure E demonstrates a complete tear that has healed without rejoining together.
These four muscles become tendons as they wrap around the ball and socket joint of the shoulder (the glenohumeral joint).

A tear in the tendon is a more severe injury than a tear in the muscle. Tendons have a poor blood supply and can take longer to heal.

If the tear is not a complete rupture (complete separation of the two parts of the tendon), then the tear will almost always mend without the need for surgery. If the tear is a complete rupture, there is a greater chance that surgery may be needed to reattach the tendon.

The good news is, that MOST rotator cuff tears are NOT complete tears, and they will heal without the need for surgery. The bad news is that the tears will fill in with, you guessed it, scar-tissue. That means tight and weak areas within the rotator cuff. That also means that parts of the rotator cuff tendons may actually end up getting welded to other healthy structures, such as the deltoid or shoulder capsule.

When the rotator cuff MUSCLE is torn, most people refer to it as a 'strained' or 'pulled muscle'. In the rotator cuff muscle, even the smallest tear can create a significant amount of damage and pain to the shoulder. (If you recall, the rotator cuff is in control of the intricate fine-tuning for the health of your entire shoulder.) The good news is muscle has a much higher blood supply and will heal MUCH faster than a torn tendon. However, the torn tissue will again heal with that nasty scar-tissue adhesion.

Depending on which rotator cuff was torn, the pain can be felt anywhere from the back of the shoulder to the front of the shoulder or deep inside the shoulder.

Most tears will also make it very difficult to lift weights, throw anything, and perform overhead type activities.

What's Going Wrong In Rotator Cuff Tears

1. Adhesion. Adhesion build-up creates a weakness where the scar mends with the muscle. This weak area is very prone to tear when stressed. Sometimes just minor or awkward movements in the shoulder can create a tear in the rotator cuff. Explosive, quick or powerful movements with the shoulder can obviously lead to larger tears whether or not adhesions are present
2. Strength and Flexibility Imbalances. Strength imbalances of the shoulder muscles can cause the rotator cuff to become overworked. An overworked muscle is more likely to tear (just ask a sprinter why his hamstrings are always tearing / pulling). Athletes are very prone to tears because of the demand of the sport usually being "one-sided" or "one-way" which causes significant imbalance. Because strength imbalances can come on gradually, the tears can also come on gradually. Consequently, the humerus can begin to ride upward and pinch the structures above it. This can lead to Impingement Syndrome, Bursitis, and Bicipital Tendonitis. If significant imbalances continue for many years, Osteoarthritis is likely.
3. Structural Damage or Alteration. COMPLETE tears of the rotator cuff tendon are a guarantee for severe Impingement Syndrome. Remember, the rotator cuff keeps the head of the humerus from riding upwards. If it is gone, the humerus is GOING to pinch upwards. Again, long-standing and severe tears, if not treated properly (whether with ART or surgery), will most likely lead to Oseoarthritis.

How Can ART Help Rotator Cuff Tears?

PARTIAL TEARS: Partial rotator cuff tears have an excellent prognosis with ART. The adhesions that build up around the tear site are the main cause of pain and dysfunction in the shoulder. ART can release the adhesions, getting rid of the pain. The secondary effect of releasing the adhesion is an increase in the strength and flexibility of the rotator cuff. This allows the humerus to be pulled into balance with the shoulder and decrease the likelihood of Impingement, Bursitis, Bicipital Tendonitis and Osteoarthritis. Once pain is diminished, proper stretching and exercises are key.

COMPLETE TEARS: In some complete tear cases, the separated pieces are close enough to mend back together. The usual case from a complete tear, though, will most likely need surgery. Post-surgery, however, most people will still feel residual tightness and achiness in the shoulder. In those cases, the remainder adhesion and scar tissue must be treated with ART for full recovery. At that point, stretches and exercises will again be key.

What if I tore my rotator cuff years ago and it still hurts? Active Release therapy directed to the site of the tear can usually resolve many of the symptoms associated with a torn rotator cuff like pain and difficulty lifting things. This is because the adhesion that forms when the tear heals is usually what causes the weakness, poor bio-mechanics, and pain within the shoulder. Even if the adhesion formed 2 years ago, it can still be removed with Active Release. If this is the case, the shoulder pain will resolve.

Success Stories of those whose main shoulder problem was a rotator cuff tear

Actual stories of actual patients at our clinic with a Rotator Cuff Tear.