Rotator cuff strain vs. tear: key differences explained

If you feel discomfort when lifting your arm above your head, pushing a grocery cart, or playing fetch with your dog, you may be experiencing rotator cuff pain. The rotator cuff is a group of four muscles and tendons that provide stability and mobility to your shoulder joint. Sometimes, these muscles and tendons in your shoulder can become ‌strained or even torn. But how can you tell if you have a rotator cuff strain vs. a tear?  

“A rotator cuff strain can feel similar to a tear, but there are some differences,” says Mary Kimbrough, PT, DPT, a physical therapist at Hinge Health. The main difference between a strain and a tear often lies in the severity of your pain. “Strains and tears can also vary in how much they affect your strength and range of motion,” Dr. Kimbrough says. But both injuries are often treated with physical therapy and targeted shoulder exercises. Movement is medicine, so staying active as you heal from a rotator cuff strain or a rotator cuff tear can help keep your shoulder joint flexible and mobile and support healing. 

Learn more about rotator cuff strain vs. tear, plus how to treat both with exercises from our Hinge Health physical therapists. 

What is a rotator cuff strain?

“A rotator cuff strain occurs when you stretch a rotator cuff muscle or tendon beyond what it’s used to,” says Dr. Kimbrough. “This can happen if you overdo physical activity, whether it’s a sport like swimming or tennis, or by doing a lot of overhead reaching.” Symptoms of a rotator cuff strain include some pain and tenderness in your shoulder, especially when you reach overhead or behind your back.

What is a rotator cuff tear?

A rotator cuff tear is a tear in one of the rotator cuff tendons. The most common one is the supraspinatus tendon, located at the back of the shoulder. “Rotator cuff tears can vary quite a bit, ranging from a very small partial tear to a full tear,” Dr. Kimbrough says. 

This may sound scary, but keep in mind that rotator cuff tendons are strong and resilient and often heal with conservative treatments. A study in the Journal of Orthopaedic Science suggested conservative treatments, including muscle strengthening and mobility exercises, were effective at treating up to 80% of full tears in the rotator cuff.   

Torn rotator cuff symptoms are similar to a strain, but with a tear, you may also notice weakness when lifting your arm, or a crackling sensation when you move your shoulder, Dr. Kimbrough says. Tears that happen from falling and landing on an outstretched hand, for example, often cause immediate pain and weakness. By contrast, tears that occur from overuse may begin as mild discomfort that gradually worsens over time.

Causes of rotator cuff strain and tear

Rotator cuff strains and tears can happen from everyday activities like doing yard work or chores to playing new sports that your body may not be conditioned to do yet. Sometimes rotator cuff injuries can occur for less obvious reasons. 

• Repetitive overhead movement. “If you ramp up an activity like painting, carpentry, or a sport like swimming or volleyball where your arm is over your head a lot, you can stress your rotator cuff muscles and tendons,” says Dr. Kimbrough. That’s especially the case if your body isn’t used to doing those specific movements.

• Acute injury. If you fall onto your outstretched arm, or lift something heavy very quickly when your body isn’t prepared for it, you can strain or tear your rotator cuff muscles or tendons. 

• Normal aging. As you get older, muscles and tendons naturally begin to change, says Dr. Kimbrough. Research suggests that blood flow to muscles and tendons during exercise can decrease as you age. “When there’s reduced blood flow to an area, your body can’t heal it as quickly,” explains Dr. Kimbrough. It’s estimated that about 30% of adults over the age of 60 have a rotator cuff tear, as do over 50% of people over the age of 80.

• Certain health conditions. Research shows that people who have hypertension or type 2 diabetes may be more likely to develop rotator cuff issues than those who don’t. Both health conditions can impair blood flow to muscles and tendons. 

• Smoking. Smoking can pose a lot of health risks, including increasing your risk for a rotator cuff strain or tear. Smoking reduces blood supply to your soft tissues (muscles, tendons, and ligaments) as well as your bones. As a result, this can make you more prone to injury while doing everyday tasks.

Exercise therapy is critical for repairing rotator cuff strains and tears. Strengthening the muscles around your shoulder joint and shoulder blades can help take pressure off your rotator cuff tendons, so they aren’t as prone to overuse. Mobility movements can increase blood flow to soft tissues in your rotator cuff and improve range of motion in your shoulder. You can use all of these exercises to help prevent and treat a rotator cuff injury. 

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment

Treatments for rotator cuff strain and tear

Whether it’s a rotator cuff strain or a tear, both respond well to conservative treatments like physical therapy and targeted exercises. Here’s what Hinge Health physical therapists recommend.

• Physical therapy and exercise. If your rotator cuff pain makes it hard to do normal daily activities, physical therapy and exercise can help, says Dr. Kimbrough. A physical therapist (PT) will discuss your symptoms with you and create a personalized treatment plan. Stretches and mobility movements help loosen up the muscles in and around your shoulders. As pain improves, you’ll focus on strengthening your shoulder and rotator cuff muscles and tendons. Research suggests that most people can heal rotator cuff tears with two to three months of physical therapy.

• Activity modifications. General physical activity is very important when healing from a rotator cuff strain or tear, as it increases blood flow and healing nutrients to the area, says Dr. Kimbrough. But you may need to modify certain activities, such as overhead motions, especially if they cause you pain. You’ll gradually get back to doing your activities normally as your rotator cuff muscles heal and become stronger. In the meantime, you can decrease shoulder strain with certain activities if you:

  • Lift objects close to your body.

  • Choose lighter weights and lift them below shoulder level (e.g. bicep curls and deadlifts).

  • Avoid pushing exercises at the gym (e.g., push-ups, bench press, and shoulder press).

  • Throw things underhand instead of overhand (think: playing fetch with your dog).

• Ice or heat. Ice is often more helpful to use within the first few days of an injury to reduce pain and swelling, says Dr. Kimbrough. Apply ice to the upper and outer portion of your shoulder muscle for 15 to 20 minutes every four to six hours. After about three days, you can switch to heat if that feels good to you, Dr. Kimbrough suggests. Taking a warm shower or bath or using a hot water bottle or moist heating pad can help support blood flow to the injured area.

• Over-the-counter (OTC) medication. Pain relievers such as ibuprofen (Advil, Motrin), naproxen (Aleve), and acetaminophen (Tylenol) can be helpful for rotator cuff pain. Another option is the over-the-counter NSAID topical cream diclofenac (Voltaren).  It’s important to talk to your doctor to make sure you can safely take these medications.

• Adjust your sleeping position. “Rotator cuff pain can make it hard to sleep at night, especially if you’re used to sleeping on the affected side,” says Dr. Kimbrough. If you’re a back sleeper, Dr. Kimbrough recommends placing the sore arm across your stomach with your elbow bent and with one or two pillows underneath to keep your shoulder in a more neutral-supported position. Side sleepers may also benefit from adding a few pillows under the affected shoulder. Keep in mind, there are no right or wrong ways to sleep. If your usual sleep position isn’t causing you pain, or you’ve found other adjustments that work for you, stick with it.

PT tip: Do a tech check

Spending a lot of time in front of screens can contribute to rotator cuff pain. “A rolled forward posture can stress your rotator cuff muscles and tendons,” says Dr. Kimbrough. She recommends taking quick breaks every 30 to 60 minutes to quickly squeeze your shoulder blades together for a few seconds. “This can help relieve tight shoulder and rotator cuff muscles,” she explains. Another option? Consider doing a doorway stretch to open up your chest and shoulder muscles. 

How Hinge Health can help you

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References 

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2. Itoi, E. (2013). Rotator cuff tear: physical examination and conservative treatment. Journal of Orthopaedic Science, 18(2), 197–204. doi: 10.1007/s00776-012-0345-2

3. Olive, J. L., DeVan, A. E., & McCully, K. K. (2002). The effects of aging and activity on muscle blood flow. Dynamic Medicine, 1(1), 2. doi: 10.1186/1476-5918-1-2

4. Giri, A., O’Hanlon, D., & Jain, N. B. (2023). Risk factors for rotator cuff disease: A systematic review and meta-analysis of diabetes, hypertension, and hyperlipidemia. Annals of Physical and Rehabilitation Medicine, 66(1), 101631. doi: 10.1016/j.rehab.2022.101631

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