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Is your shoulder pain a rotator cuff tear? Maybe.

How you can differentiate what is a rotator cuff tear and what is shoulder pain caused by other diagnoses?

How you can differentiate what is a rotator cuff tear and what is shoulder pain caused by other diagnoses?
How you can differentiate what is a rotator cuff tear and what is shoulder pain caused by other diagnoses?Read moreiStockphoto (custom credit)

Does your shoulder hurt? If you search the internet for shoulder pain, the main cause is likely to come up as a rotator cuff tear, but that is not the only cause of shoulder pain.

How you can differentiate what is a rotator cuff tear and what is shoulder pain caused by other diagnoses? And how can you eliminate some of that shoulder pain?

The rotator cuff is four muscles in the back of the shoulder. It is most commonly torn without any traumatic incident or major accident, with the tear occurring bit by bit over time. Then one incident, such as shutting a door or pulling a key out of the door, will cause it to completely tear, causing intense pain.

Poor posture is a factor in tearing the rotator cuff. When we slouch forward to watch TV, look at our phones, work on our computers, we wind up pinching the rotator cuff. The shoulder has the humerus (the arm bone) and the acromion (the bone on top). The rotator cuff runs through a space between the two bones. The more we slouch, the more muscle gets pinched as that space slowly closes, with the acromion slowly sawing the muscle until it tears. This can take years. So, while the painful tear may seem to happen suddenly, actually the muscle has usually been fraying for a while.

There are two types of rotator cuff tears: full and partial. A partial tear means that the muscle is not completely torn in half. A full tear means the muscle was torn in half and no longer intact.

With a partial tear — and sometimes even with a full tear — physical therapy has been shown to have better results than surgery.

As with any injury, most of the time there is more than just one thing causing shoulder pain; there is also probably some tendinitis and some impingement and other issues. If you just target the rotator cuff and work on fixing that, you may not eliminate the pain entirely. All the causes of the pain must be treated.

To find out if a rotator cuff tear is causing your shoulder pain, test for a “painful arc.” Put your arm down by your side with your thumb pointing away from your body. Lift your arm straight out to the side until you hit a spot where it hurts, then continue to lift it overhead until the pain stops. This is the painful arc.

In another test, again stand with your arm down by your side. Point your thumb towards your body so it is touching your leg. Raise your arm at a 45-degree angle halfway between the front and the side, up to shoulder height, making sure that your thumb stays pointed down.

If you have pain with either test, that is a sign of a rotator cuff tear. Note that going past shoulder height will hurt even those with a healthy shoulder.

So now what? Here are a few exercises you can do and life changes you can make to start feeling better immediately.

The biggest change should be good posture, to avoid pinching the rotator cuff. Find something in your everyday life that forces you to stand up and stop sitting. You don’t have to take a long break, just stand up to give your muscles a break and reset your posture. Maybe stand every time the phone rings.

Setting an alarm for every 15 minutes to stand up is a great way to get yourself into the habit. But unless you associate that habit with something that you already do and you form it into a habit, the minute you stop using the timer, chances are you are not going to forget.

When you stand, roll your shoulders up, back, and drop them down. Don’t try to pin them back and squeeze your shoulder blades together because that is overcorrection in the wrong direction. This is the first exercise you should be doing several times an hour throughout the day in order to help relieve your shoulder pain. It is a simple exercise, but it needs to be done often to retrain your shoulders to be where they need to be.

The next exercise is raising your shoulder normally. This may sound simple, and it is — but it is very difficult to do if you have trained your shoulder to do something else, which is often the case with shoulder pain. Stand in front of the mirror and raise your shoulder out to the front and out to the side and watch and make sure you don’t shrug your shoulder. Make sure that before you start this exercise you roll your shoulders up, back, and drop them down to put the shoulder in the correct position. Repeat 30 times in each direction.

You will need to do this often to retrain your muscles.

For the last exercise, squeeze your shoulder blades. Picture a towel between them. Roll your shoulders up, back, and drop them down. Then squeeze your shoulder blades together and pinch them together. Hold it for three seconds; repeat 30 times.

Heather Moore, PT, DPT, CKTP, is the owner of Total Performance Physical Therapy in North Wales, Norristown and Hatfield, Pa.