3/2/12

Does a Torn Rotator Cuff Always Hurt?

A torn rotator cuff can be very painful, but would this pain necessarily come on every day? Or can a person with a painful torn rotator cuff have some good days, i.e., days without any discomfort? 
Rotator cuff tear

According to an expert I consulted with, the pain of a torn rotator cuff can actually come and go, surprisingly.

I’m a certified personal trainer and wondered about whether or not pain, from a torn rotator cuff, could take breaks every so often, providing no-pain days for the patient.

“They certainly can have good days,” says Edmond Cleeman, MD, Manhattan Orthopedic & Sports Medicine Group, P.C., Sports Medicine, Arthroscopic Knee & Shoulder Surgery. 

This surprised me, because when a rotator cuff is torn, the tendon (usually some of it, rather than all of it) is disconnected from the bone it’s supposed to be attached to; it’s torn away.

How could this sometimes be painless? I can understand this if the patient is still. But “good days” mean that the patient is using the shoulder and arm, and feeling no pain at all, despite the torn rotator cuff.

“To make things more confusing, there are many older patients walking around with rotator cuff tendon tears and don't even know it,” says Dr. Cleeman, founding member of TRIARQ, a community of orthopedists and physical therapists.

“There are MRI and ultrasound imaging studies that have found that a certain percentage of people have rotator cuff tears without symptoms. These studies took groups of people with no shoulder pain and no history of trauma and found that as people age (particularly over 60), a percentage had tears.  Some studies followed these patients and found that a percentage eventually became symptomatic.”

Tears in the rotator cuff are not always caused by a single-event trauma, such as during a heavy weight lift at the gym, in which the person suddenly feels intense pain arise in the shoulder.

Nor do rotator cuff tears necessarily result over a short time period, in which an athlete repeatedly performs the activity that initiated a small tear, such as throwing or a particular weight-lifting routine.

Many tears happen over time in older people, a part of aging, particularly in people who are not physically fit. The tendons degenerate over time, and a tear results.

A comprehensive strength-training program, especially when initiated during young adulthood, will go a tremendous way in helping prevent tendon degeneration down the road.

However, even an intense strength training program is no guarantee against an acute injury of the rotator cuff.

For example, the strongest guy in the gym one day plays beach volleyball. 
He leaps for the ball and dives into the sand for it, his arm outstretched before him, palm down, as he slides into the sand. 

This is a very potential recipe for a shoulder tendon injury.

Thinking he should work through the pain that continues to persist several days later, he decides to do some bench pressing, further injuring the shoulder tendons. 

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