What a rotator cuff tear feels like
The rotator cuff is a set of four small muscles that sit around the top of your arm bone. Their job is to hold the shoulder steady and lift the arm. When one of them tears, the shoulder gets sore and weak.
My patients in Abu Dhabi usually describe two things. The first is pain when they lift the arm out to the side, or reach up to a high shelf. The second is night pain. They cannot lie on that side. They wake at two in the morning with a deep ache. Many tell me they have not slept properly for months, and that this, more than the pain itself, is what finally brought them in.
It is not the same as a frozen shoulder
People often mix these two up, so it is worth being clear. With a frozen shoulder, the joint goes stiff. You cannot move it, and neither can anyone else, even if they lift your arm for you.
With a torn rotator cuff, the shoulder can still move. Someone else can lift your arm through a full range. It is your own power that is missing, and it hurts. Weakness with movement points to the cuff. Stiffness with no movement points to a frozen shoulder. Telling them apart matters, because the treatment is different.
Why it happens
Tears come in two ways. Some happen in one moment, with a fall or a heavy lift, and the pain and weakness start that day. Most come on slowly. The tendon wears thin over the years until part of it gives way, and there is no injury to point to at all.
That slow wear is very common with age. About one in four people over the age of 60 has a tear in one of these tendons, and about half of people over 80 do (Operative Techniques in Orthopaedics, 2015). Many of those people have no pain at all and never know. So a tear on a scan does not automatically mean you need an operation. What matters is how your shoulder actually works and how much it troubles you.
Could this be a rotator cuff problem?
A few quick questions about your shoulder. This is only to help you decide whether to get it checked. It is not a diagnosis.
The questions in this self-check
- Does your shoulder pain wake you at night, or stop you lying on that side?
- No
- Sometimes
- Most nights
- Does it hurt to lift your arm out to the side, or to reach up above your head?
- No
- Sometimes
- Often
- Does the arm feel weak, rather than just sore?
- No
- A little
- Yes, clearly weak
- If someone else lifts your arm for you, can it move through a full range?
- No, it is stiff either way
- Not sure
- Yes, it moves but mine cannot lift it
- Did the pain or weakness start after a fall or a heavy lift?
- No, it came on slowly
- Yes, it started that day
- Is it getting harder to do everyday things, such as dressing, driving, or reaching a shelf?
- No
- Sometimes
- Often
Looking after your hands is worth a few minutes. Catching things early gives the best result.
What helps
For most people, we start without surgery. Physiotherapy is the main treatment, and it works better than people expect. The idea is to train the muscles around the tear to take up the work, so the shoulder gets steady and strong again.
Simple painkillers help you sleep. A steroid injection can settle a very sore shoulder enough to let you start the exercises, and I guide the injection with an ultrasound scan so it goes to the right spot. An ultrasound scan is also how I look at the cuff in clinic. It shows me the tendons moving in real time, while you are sitting in front of me, and there is no waiting for a separate appointment.
Surgery is for particular situations. A review in the Journal of Clinical Orthopaedics and Trauma (2022) sets out when repair is worth considering: a tear that came from a clear injury, a younger patient with good muscle quality, pain that will not settle, or a shoulder that has not improved after a proper course of physiotherapy. When I do repair a cuff, I use keyhole surgery, with small cuts rather than one large one.
When to get it checked
Please get your shoulder looked at if the pain wakes you at night, if you cannot lift your arm to the side, or if the arm feels weak rather than just sore. Get it seen quickly if the weakness started suddenly after a fall, because a fresh tear from an injury is the one where timing counts most.
A shoulder that has stopped you sleeping is worth an hour of your time. In most cases I can tell you what is going on in a single visit, scan included.
Where I see patients in Abu Dhabi
I see patients at Burjeel Day Surgery Center, Al Reem Island, Gate Tower, near Shams Boutik, on Sundays and Mondays, and at Burjeel Day Surgery Center, Al Shahama, Deerfields Mall, on Tuesdays and Thursdays.
Dr. Mohamad Louay Jabban is a Consultant Orthopaedic and Upper Limb Surgeon with over 35 years of experience in Abu Dhabi and the United Kingdom. He holds the FRCS qualification from the Royal College of Physicians and Surgeons of Glasgow and a Diploma of Expert Musculoskeletal Ultrasound.
Sources
Natural History of Rotator Cuff Disease and Implications on Management, Operative Techniques in Orthopaedics, 2015.
Current concepts on management of cuff tear, Journal of Clinical Orthopaedics and Trauma, 2022.