Shoulder impingements and rotator cuff tears are two different conditions that can affect the shoulder. While both share symptoms such as shoulder pain, it’s important to distinguish between the two. Understanding the difference is essential as you search for an effective solution to your symptoms.

Rotator cuff tears and shoulder impingements are both fairly common. Research shows that rotator cuff injuries are the most common tendon injuries in adults. Older adults are especially vulnerable, with approximately 30% of adults over age 60 having a tear and 62% of adults over 80 having tears. Shoulder impingement syndrome is also relatively widespread. According to one study, shoulder impingement syndrome is believed to be the most common cause of shoulder pain, accounting for 44% to 65% of all shoulder complaints. Though both are common ailments, each has its own set of symptoms and treatment options. 

3 crucial differences between rotator cuff tears and impingements

• Underlying cause — Rotator cuff tears and shoulder impingements have fundamentally different causes. A rotator cuff tear happens when one or more of the tendons in the rotator cuff are torn. The rotator cuff is a cluster of important muscles and tendons in the shoulder that serves to support the shoulder joint and enable rotation of the arm. The tendons in the rotator cuff are thick and strong. When a tear occurs, it’s typically caused by constant overuse or a sudden injury. Excessive heavy lifting is a common cause of rotator cuff tears. While shoulder impingements also involve the rotator cuff tendons, the circumstances of the condition are different. When someone has shoulder impingement syndrome, their tendons are pinched rather than torn. This pinching occurs as the tendons rub against the shoulder blade. Shoulder impingement syndrome is typically caused by repetitive overhead activities. The condition is sometimes referred to as swimmer’s shoulder because the stress of repeated overhead swimming strokes can lead to impingement. In some cases, shoulder impingement is also caused by poor posture.
• Pain location — Where are you experiencing the most pain? The answer to this question can help determine whether you have a rotator cuff tear or a shoulder impingement. If you have shoulder impingement syndrome, you may experience pain in the shoulder and around the top of the arm. You may also feel some referred pain lower down your arm. The pain associated with a shoulder impingement is not always constant — it often comes in waves. You may notice higher pain levels whenever you engage your shoulder or put weight on your arm. Rotator cuff tear pain is similar in many ways, but the biggest difference is that it is often centered on the front of the shoulder. The pain may radiate from here down the side of your arm. After a rotator cuff tear, you may experience especially intense pain when raising your arms above your head. If you sleep on your injured side, you will likely notice more shoulder pain through the night. In general, rotator cuff tear pain tends to be more noticeable and more pervasive than pain from a shoulder impingement.
• Treatment approach — Different conditions require different kinds of treatment, so it’s important to get an accurate diagnosis. Both conditions can typically be treated effectively through physical therapy. However, the particular modalities and techniques used by your physical therapist will differ. Shoulder impingements tend to require less intensive treatments. They’re typically treated through targeted exercises, manual therapy and other data-driven PT interventions. The treatment approach for a rotator cuff tear tends to be more involved. Rest is an especially important aspect of the recovery journey. The extent of treatment necessary will depend on the severity of the tear. In some cases, surgery may be necessary. If you need surgery for your rotator cuff tear, physical therapy can help you with pre- and postsurgery programs. Presurgery programs are designed to physically prepare you for your operation. This can help reduce the risk of complications. After surgery, physical therapy is vital for rehabilitation. Your physical therapist can help you gradually regain strength and mobility as you heal.

Shoulder impingement vs. rotator cuff tear symptoms

By learning about the particular symptoms of shoulder impingements and rotator cuff tears, you can get a better understanding of what you might be experiencing. Both conditions are associated with persistent shoulder pain, but there are plenty of differences.

As mentioned in the previous section, if you have a shoulder impingement, a dull ache may accompany your shoulder pain. This ache is typically centered around the top of the shoulder. The discomfort caused by a shoulder impingement is typically localized. Unlike the pain associated with rotator cuff tears, radiating pain is not very common. In addition to pain, you may experience a range of other uncomfortable sensations. One of the most common is a grating sensation that sometimes occurs when engaging the shoulder. You may feel like the parts of your shoulder are grinding against one another. When pressing against the top of your shoulder, you may also feel a tenderness or soreness. You might notice some new weakness in your upper arm. Unlike a rotator cuff tear, this weakness is not caused by actual tissue damage. Instead, you may feel weaker simply due to persistent pain and stiffness in your shoulder.

If you’ve torn one of your rotator cuff tears, one of the most common symptoms is a sharp, piercing pain. This pain may be especially noticeable when you’re lifting or rotating your arm at the shoulder. Resting can be a good way to lower your pain levels. When you rest, try to find a good posture. Putting pressure on your injured shoulder can make your pain worse rather than better; this is why people who have sustained rotator cuff tears often experience night pains. Besides pain, other common symptoms include muscle weakness and stiffness. When rotator cuff tendons tear, the muscles in the rotator cuff lose support. This can reduce overall muscle strength in the shoulder. You may also notice that your range of motion is limited. Motions such as raising your hands above your head might become much more difficult. If you’re experiencing any of these symptoms, seeking professional treatment is an essential next step.

Rotator cuff tear vs. shoulder impingement tests

Through rigorous tests, your physical therapist can help determine the cause of your symptoms. Physical therapists assess patients through in-depth physical examinations. Your examination may include a set of functional tests, which serve to assess your current physical capabilities. For example, your physical therapist might hold up your arm at the elbow and ask you to slowly lower your arm on your own. Your ability to complete this motion helps your physical therapist get a better understanding of your strength and range of motion. Other tests may focus more on your pain and its causes. These tests help pinpoint the areas where you feel pain and the motions that lead to it. With this information, your physical therapist can work to make a pain relief plan tailored to your condition.

Combined with your medical history and reported symptoms, these tests can help your physical therapist provide an accurate assessment of your condition. Once they understand the cause of your symptoms, your therapist can create a personalized treatment plan designed to offer lasting relief.

Identify and address your shoulder condition with Lattimore Physical Therapy

When it comes to managing shoulder conditions, Lattimore Physical Therapy can help you each step of the way from diagnosis to treatment. Our team is committed to offering outstanding patient care with our personalized, hands-on approach. Whether you have a torn rotator cuff tendon or an impinged shoulder, we’re here to make your recovery a success.

Contact our team today to learn more about shoulder conditions or to schedule an initial appointment.