The cause of a torn rotator cuff can be due to a sudden trauma to the shoulder while doing sport, especially contact sports such as football. However, this type of injury can also be attributed to a gradual degeneration over time, found in patients whose work involved lifting their arm over their head, heavy lifting or other job related activities (for example, painter and decorators) and is usually seen in patients of a certain age.
While the initial or mild pain can be relieved by rest, depending on the type of damage, it tends to gradually get worse over time and may need more proactive treatments. Small tears sometimes develop and cause a lot of pain, meaning mobility of the arm and shoulder is limited. Symptoms can include pain when raising your arm, swelling, stiffness, a clicking sound when moving the arm or loss of movement in the arm. However with a dedicated therapy program, a torn rotator cuff injury can be reduced or completely healed even without surgery. Your surgeon will carry out a shoulder examination to assess the extent of the injury.
How to Test for Rotator Cuff Tears
In order to assess if there is a rotator cuff tear, your surgeon will make a diagnosis based upon a shoulder examination and by using a series of rotator cuff tear tests which we will outline below:
- The Jobe Empty Can Test
This test is carried out to check for supraspinatus. The patient is asked to abduct their shoulder with the thumb pointing downwards. The tendon is put into a position of abduction and internal rotation where the strength of the supraspinatus is tested. The doctor applies downward pressure against the arm. This test has high accuracy in detecting tears within the rotator cuff and is one of many shoulder pain tests carried out for diagnosis of such. Unusual weakness or provocation of pain confirms a positive result for this shoulder exam test.
- Shoulder Drop Arm Test
This test can be carried out with the patient either sitting or standing. The doctor passively raises the patient’s arm to 90 degrees and asks them to lower the arm slowly. A patient with a positive result is not able to lower the arm slowly and in a controlled way. This type of shoulder test, or rotator cuff injury test, is used to identify tears within the muscle group of the rotator cuff.
- Shoulder Shrug Test
This torn rotator cuff test checks if the patient imitates a shrug movement when trying to actively raise their arm. The patient is unable to raise the arm to a 90 degree elevation without raising the whole scapula or shoulder. A shrug sign is considered positive when the patient, in order to achieve a 90 degree elevation has to move the upper body. This rotator cuff injury test is a common shoulder injury test and is effective and easy to carry out.
- Lift off Test
Also known as the Gerber Test, is one of many shoulder tests carried out to determine rotator cuff injury. The patient is asked to place the back of the hand on the small of the back and they should then lift the hand back and away from the body. If this proves difficult for the patient it can be an indication of a tear.
- Belly press Test (Abdominal Compression Test)
Another valid and simple rotator cuff injury test where the patient places their hand on the abdomen. The examiner places their hand under the patient’s hand and pushes forward. The patient must resist the pressure and keep pushing their hand towards the abdomen. A patient presenting with shoulder internal rotation pain might do this type of rotator cuff tear test and a positive test is confirmed if the patient cannot hold the pressure on the doctor’s hand or if they need to extend the shoulder in order to maintain the pressure.
- The Neer’s Test
Named after the doctor who created this rotator cuff tear test, it is simple and effective and can be carried out by a medical practitioner. The patient can be in a sitting or standing position and the doctor holds his hand on the patients scapula to avoid rotation, the patient’s arm is passively elevated in a scapular range of motion. This shoulder injury test is considered to be positive if pain occurs and can be an indication of torn rotator cuff.
Symptoms and Outcome for a Torn Rotator Cuff
As we age, we are more likely to experience rotator cuff pain or injury. It is important however to have the correct diagnosis and to understand the cause and source of the shoulder pain, as not all pain around the shoulder is necessarily a rotator cuff injury. Having said this however, rotator cuff tears cause severe pain and mobility reduction so having the right diagnosis can help cure the problem and get the best treatment for your particular injury.
Your doctor will look out for some signs to determine if rotator cuff tear is the cause of your pain and will most certainly carry out some of the above mentioned rotator cuff tear tests. You should see your doctor if the following symptoms are present:
- Pain – this will be located on the outer side of the shoulder including the upper arm area. You will notice pain especially when having to carry out tasks that include having your arm over your head. Pain and discomfort at night is common and if the rotator cuff tear is severe sleep may be disturbed.
- General weakness in the shoulder – some injuries will affect movement of the arm and the ability to reach the arm overhead. The inability to hold the arm straight out from your body is a warning sign for a rotator cuff tear.
- Reduced ability to perform day-to-day tasks is an ongoing complaint of patients with rotator cuff injuries and tears. Simply daily activities, even lifting a coffee cup or washing hair becomes a painful chore!
Your treatment options with rotator cuff injury are many and if you suspect such an injury you should see your doctor, or sports doctor, as soon as possible – early intervention is definitely advisable. Carrying out some of the torn rotator cuff tests available to your practitioner will put you on the path to recovery and get your mobility back again.