Rotator Cuff Tear VS. Shoulder Impingement VS Shoulder Tendonitis

Are you dealing with shoulder pain right now? And are you wondering what the heck is going on in there? Is it a rotator cuff tear? Could it be shoulder impingement? Or do I just have shoulder tendinitis. I’ll be telling you the difference between these three common shoulder problems so that you can have a good understanding for what they are and what to do next about it.

My name is Dr. David Middaugh, and I’m a specialist physical therapist at El Paso manual physical therapy. This channel is dedicated to helping people stay healthy, active, and mobile. while avoiding unnecessary surgeries, injections and medications.

Be sure to subscribe and turn on your notifications for this channel. So you don’t miss any of the helpful videos that we put out every week means this whiteboard in a second to draw you the differences and how to understand and get your head around these different shoulder problems.

Real quick, let me just tell you some of the common things that you’ll find with shoulder problems, like rotator cuff tears, impingement and tendinitis.

Number one thing obviously is going to be pain. But specifically, pain with reaching up pain with reaching behind your back, and pain with reaching out with your arm extended, especially while you’re holding something heavy. Another time to get pain is when sleeping at night, if you lie on that shoulder and compress the shoulder joint. Sometimes that can be very painful for these type of shoulder problems. And the more severe shoulder problems like rotator cuff tears will even be painful at rest.

When you’re just doing nothing, you could just be sitting around having a meal watching TV and it hurts. But the less severe shoulder problems like impingement, and a tendinitis tend to not be as painful at rest, they tend to be more painful with movement or with activity. And let me tell you about how they’re different.

With a rotator cuff tear, there’s typically some loss of motion, it could be that it’s just painful to get into certain motions like reaching up or behind the back.

It could also be that you need help, like if you assist your arm up with the other arm, it will go up and just can’t get there on its own. With both impingement and tendinitis. It’s common to get neck problems and pain in this area or not. In this area of the body. This is called the upper trap muscle. And that muscle can get quite tight or naughty.

Whenever there’s a shoulder problem going on with shoulder tendinitis. there’s typically a focal point in the shoulder like right here, it hurts or right here, it hurts. And it’s not as diffused, meaning it’s not spread around or doesn’t change too much. It’s pretty consistently at one spot, whereas rotator cuff tears and impingement can be more diffuse, it can move around from the front to the back to the side can run down the arm a little bit, or it can be a combination of all those depending on how you feel.

And depending on the severity, severity of it that day. What I want to make sure you understand today I’m going to use a whiteboard for all three of these problems a rotator cuff tear, shoulder impingement and shoulder tendinitis are on a spectrum of shoulder pain. And the reason why they’re on a spectrum is because they’re all related one leads into the next one is a sick more severe version of the one before.

So on the left side of the spectrum here. What I’m going to put down for you here is shoulder impingement. So just for short, I’m going to abbreviate it shoulder impingement. In the middle of the spectrum, you’ve got tendinitis. And in itis, I’ve been on the foreign, you’ve got a rotator cuff tear, I’m just going to write RTC. There you go. So on shoulder impingement, what’s usually happening is the space where the ball and socket live.

Let me use my skeleton here for you. Take them off. So you can see right there. This is the space where the ball and socket is right under this overhanging bones called the acromion. That’s the area that commonly gets impinged or pinched is another way to look at it. But that space somehow gets decreased or pinched. And that’s what sets up the tendinitis in the area and eventually a tear.

But what leads up to that some of the symptoms that you’ll see is neck problems. And upper trap I’m just going to write up UT tightness, right tight and pain and that will carry on all the way to rotator cuff tear if you end up going that far. Now, if this lasts for a while, what are the symptoms you’ll see is it just kind of aches and hurts certain movements will hurt like if you’re turning a doorknob or turning a key. They won’t hurt all the time either.

A common experience that people have had is they’ll go reach for like a heavy coat and when they go pick it up, it bites them enough. moment, but picking up something like you know, like a pen or a marker or something is no big deal, or also picking up something and turning it or maneuvering it away from their body, that can be pretty painful.

And what you can gather from that is that this motion out here where you’re reaching out and picking up something heavier turning is just a lot of stress on the shoulder and it’s becoming irritated in there, it’s usually the rotator cuff muscles and tendons that become irritated. And that is what we would label an impingement situation.

The reason why people get pain into the neck and shoulder in this upper trap area, is because these muscles need to be strong and stable in order for the ball and socket out here to work properly. So oftentimes, these get achy because they’re being overused, or they’re just not being used appropriately.

You can also have pinched nerves in the neck that set up weaknesses in these muscles and the rotator cuff muscles that eventually start to create an impingement since the situation in the shoulder joint.

And if that impingement lasts long enough, it becomes severe enough, then we progress into tendinitis. So in tendonitis, I’ll use paint here, this is where you got a tender spot, tender spot on the shoulder, it begins to form are usually you can poke in there and find a spot that just gets you if you’re in, you might even want to rub it out to get some relief. And this will keep going, of course, in some rotator cuff tear.

But that tendinitis what’s happening is that the ball and socket joint where the where the muscles meet the tendons, and then the tendons meet the bones, muscles connect to tendons, tendons connect to bones, that tendon gets overused or over compressed or irritated. And it’s just like, if you rub your skin really hard, you know your skin spine normally. But if you rub it for a while, you can take it for maybe a few seconds, maybe a minute or two.

But after a while it starts to get irritated and read. It may not break, you may not bleed, but it gets irritated. And if you were to do that for an hour, if you were to do it several times a day for you know, a few minutes at a time, you bet your skin would be irritated. And it would probably take a little while for it to recover maybe a day, maybe even a few minutes depending on how hard you do it.

What you need to understand is what the tendon, it doesn’t recover as fast as your skin does. Your skin recovers really, really fast. If it gets irritated it as long as it’s in a good healing environment, which should be minutes hours at most, a couple of days. tendons is one of the timeframe of weeks to get over an irritation.

So that’s why tendonitis can last a while. And if you don’t identify if you don’t figure out what the aggravating motion is or what the aggravating thing is the thing that sets you up to get it and remove it from your situation.

It’s going to stay irritated. It’s going to stay tendinitis. tendinitis just means inflammation of the tendon. That’s why it gets irritated. Like I was saying, if that persists, if weeks go by months go by like that, then eventually that tenant becomes so irritated, as if you were to be doing this that it will break, it will break open just like your skin will break open eventually, if you were to do this, now make it a blister at first.

But eventually that blister will pop open and there could be blood under there. Same thing with a tendon, you’ll get an actual blister on your tendon, it just starts to break down and tear. And that’s what sets you up for a rotator cuff tear. So when you have a rotator cuff tear, typically, let’s use green here. You have a loss of motion. And that’s when it’s serious.

Because now, you know, usually leading up to this with solar and placement and tendinitis. People can still do stuff, they can still function they can get through their day, they can clean the house, they can typically work just fine. It might be concerning to them that they have pain, but they might even be able to take a pain medication, you know, Tylenol, Motrin, ibuprofen, something like that, and deal with it.

But if you lose motion, if you just can’t reach back there anymore, if you can’t reach up if there’s things that you just can’t do, some people can’t even wash their hair, or, you know, fix their hair, or cook a meal because of their shoulder pain. That’s when it’s serious. And ideally, you don’t want to get to this point where you’ve got a loss of motion.

You want to start treating the problem when you’ve got just a tendinitis are an impingement issue. But if you’re at this point where you’re having difficulty moving your arm, it’s pretty bad, you’re gonna make sure you do something about it. So I hope this makes sense to you. 

I hope you better understand what a rotator cuff tendon tear is, what an impingement is and what a tendinitis is here and other on a spectrum and as you move along from left to right here, it gets more painful, more limiting and more serious.

Now the good news you need to take away from this is that even if You’ve got a rotator cuff tear, and you’re concerned, you’re losing motion, you still have an excellent chance at healing it naturally without surgery. But current research shows us that people who get surgery versus people that don’t get surgery and go through conservative care, which means physical therapy, usually, they ended up about the same six months later.

And even 12 months later, they both get more emotion back and get a reduction in pain. And they’re pretty good. So why even do the surgery now there are cases where it’s pretty severe. And there’s it’s been going on for a while, maybe it’s not the first rotator cuff tear where you could go get the surgery right away.

But in most cases, you can get away with not having surgery, and healing this rotator cuff problem naturally, if you’ve got a rotator cuff tear, and you’re looking for exercises to do, I’ve got a video for you called How To Treat a rotator cuff tear at home. It’s in the description below, you can find the link in there.

And if you’ve got more of a tendinitis or a shoulder impingement problem, there’s another link for our playlist covering a bunch of shoulder and neck exercises and stretches and tips and advice as well.

And the reason why there’s neck stuff in there is because as I said in this video, you can get neck issues and upper tract problems that feed into a shoulder problem. So it’s important to get that addressed as you’re fixing yourself so that you don’t end up taking it all the way to a rotator cuff tear. You got any questions on this? Drop a comment below.

We’ll get to it as fast as we can. And I hope that you liked this video. If you did, give us a like give us a thumbs up. And don’t forget to subscribe and turn on notifications so you don’t miss any of the helpful videos and tips we put out each week. Have a wonderful day guys.