Blog 2: The Rotator Cuff Fix
Part 2: Rotator Cuff Injuries - Symptoms, Types & What You're Actually Dealing With
So you read Part 1 and now you understand what your rotator cuff is and how it works. Awesome! Now let's talk about what happens when things go wrong.
As your Oakville chiropractor at Endurance Therapeutics who sees shoulder problems every single week, I'm going to break down the different types of rotator cuff injuries and how to recognize what you're dealing with.
The Rotator Cuff Injury Spectrum
Here's what most people don't realize: "rotator cuff injury" isn't just one thing. It's actually a spectrum of problems ranging from mild irritation to complete tears.
Think of it like a rope:
- Mild issues: The rope is frayed but still intact
- Moderate issues: The rope is significantly damaged with some fibers torn
- Severe issues: The rope is completely snapped
Let's break down each type!
Type 1: Rotator Cuff Tendinopathy (The "Angry Tendon")
What it is:
- Irritation and inflammation of the rotator cuff tendons
- The tendon tissue becomes painful and doesn't function properly
- No actual tear—the tendon is still intact but unhappy
- Most common in younger, active people
What it feels like:
- Dull, achy pain in the shoulder
- Pain with overhead activities
- Discomfort when reaching behind your back
- Usually worse at night or after activity
- Might feel okay at rest but hurts with movement
How it happens:
- Repetitive overhead movements (swimming, throwing)
- Sudden increase in activity
- Poor posture creating impingement
- Muscle imbalances around the shoulder
The good news: This is the most common rotator cuff problem and responds really well to treatment!
Type 2: Rotator Cuff Impingement (The "Pinched Tendon")
What it is:
- Your rotator cuff tendons get pinched in the narrow space under your shoulder blade
- Creates inflammation and pain
- Often goes hand-in-hand with tendinopathy
- Can lead to more serious problems if ignored
What it feels like:
- Sharp pain when lifting your arm to the side (especially between 60-120 degrees)
- A "pinching" sensation in the shoulder
- Pain reaching overhead or behind your back
- May feel like something is "catching" in your shoulder
- Often worse at night, especially lying on that shoulder
Common complaints I hear:
- "It hurts to put on my jacket"
- "I can't sleep on that side"
- "It's fine until I lift my arm to a certain height, then it kills"
- "I can't reach up to grab things from the shelf"
How it happens:
- Poor shoulder blade positioning (often from posture)
- Weak rotator cuff muscles
- Bone spurs narrowing the space
- Muscle imbalances
- Repetitive overhead activities
Type 3: Partial-Thickness Rotator Cuff Tear (The "Partially Torn Rope")
What it is:
- Some of the tendon fibers are torn, but the tendon isn't completely separated
- Can be on the top side (bursal side) or bottom side (articular side) of the tendon
- More serious than tendinopathy but not as bad as a full tear
What it feels like:
- Moderate to severe pain with activity
- Significant weakness when lifting your arm
- Pain at night that might wake you up
- Difficulty with overhead activities
- May hear or feel clicking or popping
How it happens:
- Progression from untreated tendinopathy or impingement
- Acute injury (fall, lifting something heavy)
- Degenerative changes over time
- Combination of overuse and trauma
Important note: Partial tears can progress to full tears if not treated properly!
Type 4: Full-Thickness Rotator Cuff Tear (The "Completely Torn Rope")
What it is:
- The tendon is completely torn—goes all the way through
- Can be a small tear or a massive tear involving multiple tendons
- Most serious type of rotator cuff injury
What it feels like:
- Severe pain (though sometimes surprisingly less painful than partial tears!)
- Significant weakness—may not be able to lift arm at all
- May feel or hear a "pop" when it tears (in acute tears)
- Difficulty or inability to perform daily activities
- Night pain that's really disruptive
Two types of full tears:
Acute Tears (Sudden):
- Happen from a specific incident (fall, lifting, sports injury)
- Usually very painful when they happen
- More common in younger, active people
- Better prognosis for healing
Degenerative Tears (Gradual):
- Develop slowly over time from chronic wear and tear
- May not even remember when it started hurting
- More common in people over 50
- May have had symptoms for a while before the final tear
How it happens:
- Fall onto an outstretched arm
- Lifting something very heavy
- Sudden pulling or jerking motion
- Progression from a partial tear
- Years of repetitive overhead work or sports
Common Symptoms Across All Rotator Cuff Injuries
Regardless of the specific type, most rotator cuff problems share some common symptoms:
Pain Patterns:
- Pain on the outside/top of your shoulder (not usually at the joint itself)
- Worse with overhead activities
- Night pain (this is a BIG red flag for rotator cuff problems!)
- Pain reaching behind your back (like tucking in your shirt or reaching for your wallet)
- Discomfort lying on the affected shoulder
Weakness:
- Difficulty lifting your arm, especially to the side
- Trouble with overhead activities (putting things on shelves, washing your hair)
- Decreased throwing velocity or power in sports
- Arm feels "heavy" or "dead"
Functional Limitations:
- Can't put on a jacket normally
- Difficulty washing or brushing your hair
- Trouble reaching for your seatbelt
- Can't carry groceries on that side
- Swimming, throwing, or overhead sports become impossible
Special Tests: How We Diagnose Rotator Cuff Injuries
At Endurance Therapeutics, I use several specific tests to figure out exactly what's going on with your shoulder:
Painful Arc Test:
- You lift your arm out to the side
- Pain between 60-120 degrees = positive for impingement
Empty Can Test (Supraspinatus Test):
- Arm extended forward and angled slightly inward (like pouring out a can)
- I push down while you resist
- Pain or weakness = possible supraspinatus problem
External Rotation Test (Infraspinatus/Teres Minor):
- Elbow at your side, bent to 90 degrees
- Rotate your arm outward against resistance
- Pain or weakness = possible infraspinatus or teres minor issue
Internal Rotation Test (Subscapularis):
- Hand behind your back
- Push your hand away from your back against resistance
- Pain or weakness = possible subscapularis problem
Drop Arm Test:
- Arm lifted to the side at 90 degrees
- Slowly lower it down
- Can't control the descent = possible rotator cuff tear
The "Red Flags" That Mean You Should Get Help NOW
Come see me (or another healthcare provider) ASAP if you experience:
🚩 Sudden, severe shoulder pain after an injury or fall
🚩 Complete inability to lift your arm
🚩 Visible deformity or swelling
🚩 Numbness or tingling down your arm
🚩 Night pain that consistently wakes you up
🚩 Symptoms that are getting progressively worse
🚩 Pain lasting more than 2 weeks despite rest
Age and Rotator Cuff Injuries: What to Expect
Under 30:
- Usually tendinopathy or impingement from overuse
- Rarely degenerative tears
- Heal faster and more completely
- Often related to sports or sudden increase in activity
30-50:
- Mix of overuse injuries and early degenerative changes
- Partial tears becoming more common
- May have both work-related and sports-related issues
- Still heal well with proper treatment
Over 50:
- Higher risk of tears, even from normal activities
- Often combination of degeneration and acute injury
- May have tears without even knowing it (some are asymptomatic!)
- Treatment focuses on function and pain management
Interesting fact: Studies show that many people over 60 have rotator cuff tears on imaging but NO PAIN OR SYMPTOMS! This tells us that having a tear doesn't automatically mean you'll have problems.
How Rotator Cuff Injuries Progress (If Ignored)
Here's what often happens if you ignore early symptoms:
Stage 1: Mild tendinopathy
- "It's just a little sore after I play tennis"
- Easy to treat at this stage!
Stage 2: Impingement and more significant tendinopathy
- "It hurts more often now, especially at night"
- Still very treatable, but takes longer
Stage 3: Partial tear
- "I can barely lift my arm overhead anymore"
- Requires more intensive treatment
Stage 4: Full tear
- "I heard something pop and now I can't use my arm properly"
- May require surgical consultation
The lesson: Like any injury, early treatment prevents progression! Don't be the person who waits until Stage 4!
The Difference Between Rotator Cuff Problems and Other Shoulder Issues
Not all shoulder pain is rotator cuff related! Here's how to tell the difference:
Rotator Cuff Injury:
- Pain on the outside/top of shoulder
- Worse with overhead movements
- Significant night pain
- Weakness with specific movements
Frozen Shoulder (Adhesive Capsulitis):
- Extreme stiffness and limited range of motion in ALL directions
- Pain at the end ranges of movement
- Usually develops gradually
Shoulder Arthritis:
- Deep, aching pain in the joint itself
- Grinding or crunching sensations
- Stiffness, especially in the morning
- Usually older adults
Labral Tear:
- Deep pain inside the shoulder joint
- Clicking, catching, or popping
- Feeling of instability
- Common in throwing athletes
Why Accurate Diagnosis Matters
Understanding exactly what type of rotator cuff injury you have is crucial because:
- Different injuries need different treatments
- Some get better with conservative care, others might need surgery
- The timeline for healing varies dramatically
- Knowing what you have helps set realistic expectations
At Endurance Therapeutics, I take the time to properly assess your shoulder and figure out exactly what's going on—not just slap a generic diagnosis on it.
The Bottom Line
Rotator cuff injuries range from mild tendinopathy to complete tears. The key symptoms to watch for are:
- Pain on the outside/top of your shoulder
- Weakness with specific movements (especially lifting to the side)
- Night pain that disrupts sleep
- Difficulty with overhead activities and reaching behind your back
The good news: Most rotator cuff problems can be successfully treated without surgery when caught early and managed properly!
Coming up in Part 3: We'll explore how rotator cuff injuries happen, which sports and activities put you at highest risk, and who is most susceptible to these problems!
Think you might have a rotator cuff injury? Dr. Keirstyn can properly diagnose and treat your shoulder problem at our Oakville clinic. Book your assessment today!