Can You Have a Rotator Cuff Tear Without Symptoms?

The answer to this question is yes – it is possible to have a rotator cuff tear without experiencing any noticeable symptoms, particularly in the early stages. Rotator cuff tears can occur gradually over time or as a result of a sudden injury, such as a fall or lifting a heavy object. Some individuals may have small tears or partial tears that do not cause significant pain or discomfort.

However, as the tear progresses or if it becomes larger, symptoms such as shoulder pain are more likely to appear. Recently, our clinics have seen an increase in patients with subacromial shoulder pain, also known as shoulder impingement which affects shoulder movement and function, particularly when lifting the arm or turning the arm outwards. Some patients have raised questions about the possibility of having a torn rotator cuff without experiencing pain or functional limitations. As experienced physiotherapists, we aim to provide answers and insights into this phenomenon.

What is a Rotator Cuff Tear?

A rotator cuff tear refers to a tear or rupture in one or more of the tendons that make up the rotator cuff, which is a group of muscles and tendons that stabilize and help move the shoulder joint. The rotator cuff consists of four main tendons: the supraspinatus, infraspinatus, teres minor, and subscapularis. Consequently, we’ve been asked whether a torn rotator cuff can exist without causing pain or functional issues. To address these concerns, let’s explore the correlation between diagnostic tests and symptom severity.

Why can a patient have a rotator cuff tear without symptoms?

The Discrepancy between Pathology and Symptoms

Diagnostic tests like x-rays and MRIs commonly assess shoulder conditions. However, they often fail to reflect the actual level of pathology. This inconsistency is not limited to rotator cuff tears; similar discrepancies have been observed in arthritis and discal pathology. In our clinical experience, we’ve seen patients with significant imaging findings but minimal complaints, as well as those with inconspicuous scans but severe symptoms. This incongruity prompts us to explore the possibility of asymptomatic rotator cuff tears.

The Prevalence of Asymptomatic Rotator Cuff Tears

Numerous studies have investigated the occurrence of rotator cuff tears in individuals without shoulder pain or functional limitations. In 1999, Tempelhoff et al. conducted an ultrasound scan on 411 people with asymptomatic shoulders and found that 23% of them had tears. Another recent study by Hinsley et al. in 2022 examined 1003 women aged 63 to 87 and discovered that 22% of the population had full-thickness tears, with almost half of them being asymptomatic. These findings highlight the possibility of having a tear without experiencing any symptoms.

How is it possible to have a full-thickness tear yet no loss of function? 

The Suspension Bridge Concept: Maintaining Function with a Tear

To understand how individuals can maintain function despite a rotator cuff tear, we can look to the suspension bridge concept described by Burkhard et al. Imagine the shoulder joint from a top-down view, with the tear located at the top of the “bridge,” representing the supraspinatus muscle. If the anterior and posterior rotator cuff, comparable to suspension towers, remain intact and function properly, the overall shoulder function can be preserved. This concept explains how physiotherapy can help to rehabilitate massive irreparable rotator cuff tears and help patients regain shoulder functionality by enhancing the dynamic stabilization of the anterior and posterior shoulder cuff.

Seek Physiotherapy Help for Rotator Cuff Tear

In summary, it is indeed possible to have a torn rotator cuff without experiencing symptoms. Diagnostic tests often fail to reflect the level of pathology accurately, and research has shown a significant percentage of individuals with asymptomatic shoulders having tears. Understanding the suspension bridge concept of the anatomy provides further insights into how function can be maintained despite a tear. As physiotherapists, we recognize the complexities of subacromial shoulder pain and the variations in symptom presentation. By embracing these nuances, we can better assist our patients in managing rotator cuff tears effectively. If you suspect that you might have a shoulder injury but have no symptoms, do make an appointment to speak to our team of experienced physiotherapists who are able to help manage the condition.