EPISODE 69: "Rotator Cuff Injury: It's More Than Just a Tear"

Dr. Ja'nae Brown

When an athlete injures their shoulder, they are usually worried about two things:

1. Did I tear my rotator cuff?

2. Am I going to need surgery?

The good news is that not all rotator cuff injuries result in rotator cuff tears. In fact, as a sports physical therapist, I have treated countless athletes with rotator cuff injuries over the past 20 years, and only a small percentage ultimately had a significant tear.

The bad news? Rotator cuff pathology is one of the leading causes of shoulder pain in overhead athletes.

One of my goals as a physical therapist is to save young shoulders. I know that if I can evaluate an athlete early after symptoms begin, I can often help reduce their risk of developing a more serious injury. Rotator cuff tears in younger athletes are frequently the result of repetitive overload, poor shoulder mechanics, training errors, or unresolved pain that has been ignored for too long. These are all things that can be addressed through proper education, training, and rehabilitation.

If you are an athlete struggling with shoulder pain—or a parent of a young athlete dealing with shoulder pain—this article is for you.

In this blog, we'll discuss:

• What the rotator cuff is

• Why tears occur

• Athletes most at risk

• Common signs and symptoms

• Imaging and diagnosis

• Surgical versus non-surgical treatment

• How physical therapy helps athletes return to sport

Let's get it started in here....

What is the Rotator Cuff?

The rotator cuff is a group of four muscles and their tendons that surround the shoulder joint. Together, they help stabilize the shoulder and control arm movement. Think of the rotator cuff as the dynamic stabilizer of the shoulder. While larger muscles like the deltoid generate power, the rotator cuff keeps the ball of the shoulder centered in the socket during movement.

The Four Rotator Cuff Muscles (SITS)

Supraspinatus

• Helps lift the arm away from the body (abduction)

• Most commonly injured rotator cuff tendon

Infraspinatus

• Helps rotate the arm outward (external rotation)

• Important for throwing and overhead sports

Teres Minor

• Assists with external rotation and shoulder stability

Subscapularis

• Helps rotate the arm inward (internal rotation)

• The largest and strongest rotator cuff muscle

Why athletes need it & who is at risk

The shoulder is the most mobile joint in the body, but that mobility comes at the cost of stability.

The rotator cuff:

✔ Keeps the shoulder stable

✔ Helps lift and rotate the arm

✔ Controls movement during throwing, swimming, serving, and lifting

✔ Protects the shoulder from excessive stress

Athletes Who Depend Heavily on Their Rotator Cuff:

• Baseball and softball players

• Swimmers

• Tennis players

• Volleyball players

• Football quarterbacks

• Weightlifters

• CrossFit athletes

  
  

Signs and symptoms

Rotator cuff pathology can range from mild tendon irritation (tendinopathy) to partial- or full-thickness tears. Symptoms often develop gradually but can also occur suddenly after an injury.

Common Symptoms

1. Shoulder Pain

• Pain on the outside or front of the shoulder

• Pain that may radiate down the upper arm

• Pain during or after activity

• Pain that worsens with overhead movements

2. Painful Overhead Activities

Athletes may notice pain when:

• Throwing

• Serving a tennis ball

• Swimming

• Reaching overhead

• Performing shoulder presses

• Putting items on a high shelf

3. Night Pain

• Pain when lying on the affected shoulder

• Difficulty finding a comfortable sleeping position

• Waking up due to shoulder pain

4. Weakness

• Difficulty lifting the arm

• Reduced strength with pushing, pulling, or overhead activities

• Loss of throwing velocity or endurance

5. Decreased Range of Motion

• Difficulty reaching overhead

• Trouble reaching behind the back

• Stiffness, especially after activity

6. Painful Arc

• Pain when lifting the arm, often between approximately 60° and 120° of elevation

7. Clicking or Catching

• Some individuals report clicking, popping, or catching sensations

  
  

Signs of a Rotator Cuff Tear

Partial-Thickness Tear

• Pain is often the primary complaint

• Mild-to-moderate weakness

• Able to move the arm, but certain activities are painful

Full-Thickness Tear

• Significant weakness

• Difficulty lifting the arm overhead

• Loss of strength during daily activities

• Sometimes associated with a sudden injury and a sensation of a "pop"

What Athletes Often Notice First

Athletes rarely say, "I think I tore my rotator cuff."

Instead, they often report:

• "My shoulder feels weak."

• "I can't throw as hard as I used to."

• "My shoulder hurts after practice."

• "I can't sleep on that side."

• "I feel a pinch when I lift my arm overhead."

Takeaway: Rotator cuff pathology doesn't always start with a tear. Many athletes first experience pain, weakness, reduced endurance, or difficulty with overhead movements long before significant tendon damage occurs. Early evaluation and treatment can often prevent a minor problem from becoming a major injury.

Imaging and Treatment Options

Many athletes assume that shoulder pain automatically means a tear. Fortunately, that is often not the case.

X-rays can help identify bony abnormalities, while MRI imaging can reveal tendon irritation, partial tears, or full-thickness tears. However, imaging findings do not always correlate with pain or function. In fact, many athletes have abnormalities on MRI but continue to perform at a high level without symptoms.

Not all rotator cuff tears require surgery.

Many cases of rotator cuff tendinopathy, partial-thickness tears, and even some full-thickness tears can be successfully managed with physical therapy and progressive strengthening. That means with good PT, you can heal your injury.

Surgery may be considered when:

• Significant weakness is present and rehab is unsuccessful

• A traumatic full-thickness tear occurs

• The athlete cannot return to desired activities

The decision should always be made based on the athlete's goals, symptoms, function, and overall clinical presentation—not MRI findings alone.

How physical therapy helps athletes return to sport

A rotator cuff injury doesn't just affect the shoulder—it can impact strength, mobility, power, endurance, and confidence. Physical therapy helps athletes address the underlying cause of their symptoms and safely return to the activities they love.

1. Reduce Pain and Irritation

The first goal is often to calm down the injured tissue and reduce pain.

Physical therapy may include:

• Activity modification

• Manual therapy

• Mobility exercises

• Progressive loading strategies

• Education on training volume and recovery

  
  

2. Restore Mobility

Many athletes with rotator cuff pathology have restrictions in:

• Shoulder mobility

• Thoracic spine mobility

• Rib cage movement

• Soft tissue flexibility

Improving mobility can reduce stress on the rotator cuff during sport-specific movements.

3. Improve Shoulder Stability

The rotator cuff functions as a stabilizer of the shoulder joint.

Physical therapy focuses on:

• Rotator cuff strengthening, Scapular stabilization, Neuromuscular control, Dynamic shoulder stability

The goal is to help the shoulder remain stable during high-speed and high-force movements like throwing.

4. Address the Entire Kinetic Chain

The shoulder does not work alone.

For overhead athletes, we often assess:

• Core strength

• Hip mobility

• Lower extremity strength

• Trunk control

• Movement mechanics

Deficits elsewhere in the body can increase stress on the shoulder.

5. Rebuild Strength and Power

As symptoms improve, athletes progress into:

• Strength training

• Plyometrics

• Power development

• Sport-specific training

The goal is not just to eliminate pain but to restore performance.

6. Return-to-Sport Testing

Before returning to full participation, athletes should demonstrate:

• Adequate strength

• Near symmetrical function

• Good movement quality

• Sport-specific readiness

Objective testing can help determine if an athlete is truly ready to return.

7. Prevent Re-injury

Perhaps the most important goal is reducing the risk of future injury.

Physical therapy helps athletes:

• Understand contributing factors

• Improve training habits

• Optimize movement patterns

• Build resilience for long-term performance

Final Thoughts

At Physical Therapy San Pedro, we don't just treat the rotator cuff—we evaluate the entire athlete. By identifying movement limitations, strength deficits, and performance barriers, we help athletes return to sport safely, confidently, and at their highest level.

Struggling with an injury?

At Physical Therapy San Pedro, we help athletes return to sport safely by combining evidence-based rehabilitation with performance-focused training and movement analysis.

If shoulder pain is limiting your training or performance, our team is here to help you move better, recover confidently, and get back to doing what you love.

If you’re in the San Pedro or Los Angeles area and looking for some help, we are a practice that reflects these values — individualized care, intentional programming, and long-term performance. We’d love to work with you at Physical Therapy San Pedro.

For those outside the area, we also offer telehealth sessions and online programs focused on ankle and knee pain, designed for athletes who want to keep progressing no matter where they’re located.

Stay Connected & Take the Next Step

📅 Book an in-person or virtual session at Physical Therapy San Pedro

🌐 https://physicaltherapysanpedro.com

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📞 (424) 536-3023

📍 415 W 6th Street, San Pedro, CA 90731

Stay strong. Stay moving.

❤️ Dr. Brown