Shoulder Pain From A Rotator Cuff Tear: Not Likely!
By Dr. Mitchell Yass – Stop the Pain, I Want My Life Back
I can’t believe how many patients I treat who had pain at the shoulder and then received an MRI that indicated that there was a rotator cuff tear and were then told that the rotator cuff tear was the cause of the shoulder pain.
The unfortunate ones were manipulated into getting a surgery that they never needed and usually still had the same pain if not worse after the surgery. The lucky ones who found out about me usually had therapy unrelated to the MRI finding of a rotator cuff tear, had their pain resolved and lived very happily there after. The nice orthopedist who is informing you about the MRI finding of a rotator cuff tear may be neglecting to mention that studies have shown that the same positive finding of a rotator cuff tear can be found in people with absolutely no pain in almost the same percentages as those with pain. So how can it be that so many people can have rotator cuff tears that have no pain? It is simple. The rotator cuff tears being identified on the MRI are degenerative tears that have occurred over long periods of time. They are so slow in their progression that a pain signal is not emitted. That is why so many people have rotator cuff tears and no complaint of pain. So the identification of a rotator cuff tear is completely independent of pain. The only question is when you get the MRI, when you have pain or when you don’t.
So if the rotator cuff tear is not creating your pain then what is? This is usually a pretty straight forward question. In my practice, I have found that most people who have shoulder pain have the pain at the front of the shoulder or the side of the shoulder. If the pain is at the front of the shoulder, this is usually indicative of biceps tendinitis secondary to a rotator cuff strain. The rotator cuff can strain if the requirement of strength of the muscle group due to an activity is greater than the available force output of the muscle group. The muscle will become knotted. This makes it difficult for the muscle to perform its functional task of keeping the arm bone in the shoulder joint. Once the rotator cuff strains, the arm bone can raise in the shoulder joint and impinge on the bicep tendon that passes through the shoulder joint just above the arm bone. The impinging of the bicep tendon will create pain at the top/front of the shoulder joint.
Pain at the lateral shoulder typically signifies that a muscle called the brachialis has strained. This muscle attaches along the lateral aspect of the upper arm bone. If the rotator cuff strains, there is shoulder dysfunction. This will cause the shoulder joint to be used less to raise the arm. Since the arm can be raised either at the shoulder or elbow, the arm will be raised at the elbow more frequently and used for more functional tasks. The brachialis flexes the elbow so it can become overused and strained creating the pain at the lateral shoulder and upper arm.
The only reason to ever believe that a rotator cuff tear is creating pain at the shoulder is when the pain is associated with a traumatic event such as if an individual falls off a ladder or an individual has to secure an excessively heavy item that is uncontrolled. In the vast majority of cases I have treated for shoulder pain, the person could not remember the incident that initiated their shoulder pain or the incident was very benign in its severity.
The key to proper treatment is understanding what tissue is creating the pain signal and treating the distress of that tissue. It has become a well established fact that MRIs cannot correlate positive findings such as herniated discs, stenosis, meniscal tears or rotator cuff tears to pain. A clinical evaluation which includes an understanding of how the injury occurred, range of motion testing, strength testing and palpation (feeling for the tissue that is emitting the pain signal) is the key to proper diagnosis. Ultimately, in most cases I have found the cause of shoulder pain to be muscle weakness and strain. Through targeted strength training, I have fully resolved the pain without the need for surgery, cortisone shots or medication.
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