Is It a Rotator Cuff Tear — Or Just Inflammation?
Short Answer
Shoulder pain and weakness may be caused by rotator cuff tendon inflammation, degeneration, calcification, or a partial or full tear. Symptoms can overlap. Proper clinical assessment and, where appropriate, imaging help clarify whether structural tearing is present or whether inflammation and biomechanical factors are contributing.
What Is the Rotator Cuff?
The rotator cuff is a group of four tendons that:
- Stabilize the shoulder joint
- Control arm lifting
- Support overhead movement
Because the shoulder relies heavily on tendon control, irritation or degeneration can cause noticeable symptoms.
What Is Rotator Cuff Inflammation?
Tendon inflammation (tendinitis) or irritation may develop due to:
- Repetitive overhead use
- Strain
- Poor scapular control
- Mechanical impingement
- Age-related degeneration
Symptoms may include:
- Pain when lifting the arm
- Night discomfort
- Painful arc during movement
- Mild weakness due to pain
Inflammation does not necessarily mean a tear is present.
What Is a Rotator Cuff Tear?
A tear involves structural disruption of the tendon.
It may be:
- Partial thickness
- Full thickness
- Degenerative (age-related)
- Traumatic (after a fall or injury)
Symptoms may include:
- Significant weakness
- Difficulty lifting the arm
- Persistent night pain
- Reduced active range of motion
However, some small tears may produce mild symptoms.
Why Symptoms Can Overlap
Both inflammation and tears may cause:
- Pain with elevation
- Weakness
- Night discomfort
- Reduced tolerance for overhead activity
This is why symptoms alone cannot always determine severity.
What About Calcification?
Calcific tendinitis occurs when calcium deposits form within the rotator cuff tendon.
This may cause:
- Sudden severe pain
- Marked inflammation
- Night pain
- Limited lifting
Calcification can sometimes mimic a tear in symptom intensity.
X-ray or ultrasound may help identify deposits.
What About Frozen Shoulder?
Frozen shoulder (adhesive capsulitis) involves:
- Progressive stiffness
- Capsular thickening
- Adhesions within the joint
Unlike a tear, frozen shoulder typically causes:
- Global restriction of movement
- Both active and passive motion limitation
Weakness is often secondary to stiffness rather than structural rupture.
When Is Imaging Helpful?
Imaging may be considered when:
- Weakness is significant
- Trauma occurred
- Pain persists despite structured care
- Range of motion declines
- Surgical planning is being considered
MRI or ultrasound may help identify:
- Tendon tears
- Degeneration
- Calcification
- Bursitis
- Capsular thickening
Imaging findings must be correlated clinically.
Some degenerative tears may be present without severe symptoms.
Where Shockwave May Be Considered
Shockwave therapy may be considered in selected cases such as:
- Calcific tendinitis
- Chronic tendon irritation without major tear
Shockwave is typically used as part of a broader rehabilitation plan.
It does not repair full-thickness tears.
Suitability depends on diagnosis and structural findings.
Why Shoulder Pain Is Often Multi-Factorial
Symptoms may involve:
- Tendon inflammation
- Partial tearing
- Calcification
- Capsular stiffness
- Muscle imbalance
- Mechanical impingement
Treating only one layer may not address all contributors.
The Four-Layer Integrated Shoulder Model™
Our clinic applies a coordinated outpatient framework.
Layer 1 — Medical Pathology Assessment
Doctor evaluation of tendon integrity, inflammation, calcification, and capsular condition.
Layer 2 — Imaging Clarity (Where Appropriate)
Medical interpretation of MRI, ultrasound, or X-ray findings.
Layer 3 — Biomechanical & Muscular Evaluation
Licensed physiotherapist assessment of:
- Rotator cuff strength
- Scapular control
- Movement mechanics
- Range of motion
- Load tolerance
Layer 4 — Targeted Non-Invasive Medical Technology
Where suitable, modalities may complement rehabilitation planning.
Doctor and physiotherapist discuss findings face-to-face within the same clinic.
When Should You Seek Evaluation?
Consider professional assessment if:
- You cannot lift your arm
- Weakness develops suddenly
- Night pain persists
- Movement becomes progressively limited
- Symptoms recur repeatedly
Early clarification helps guide appropriate next steps.
Conclusion
Shoulder pain may be due to:
- Rotator cuff inflammation
- Partial or full tear
- Calcification
- Frozen shoulder
- Mechanical impingement
- Muscle imbalance
Symptoms often overlap.
Clinical assessment and appropriate imaging help clarify structural versus inflammatory contributors.
1️⃣ How do I know if I have a rotator cuff tear?
Significant weakness, difficulty lifting the arm, or persistent night pain may suggest a tear. Imaging may help clarify.
2️⃣ Can rotator cuff inflammation feel like a tear?
Yes. Tendon inflammation may cause pain and weakness similar to partial tears.
3️⃣ Does calcific tendinitis mean the tendon is torn?
No. Calcification involves calcium deposits within the tendon and does not automatically indicate a tear.
4️⃣ What is the difference between frozen shoulder and a tear?
Frozen shoulder primarily causes stiffness and restricted motion, while a tear often causes weakness and pain during movement.
5️⃣ Do all rotator cuff tears need surgery?
Management depends on tear size, functional limitation, and response to conservative care.
What To Expect When I Visit The Pain Relief Clinic
A typical visit will involve our doctor first understanding your medical history, concerns and previous experience with other pain treatments.
For patients who have consulted many people but have yet to receive a clear diagnosis, selecting an affordable imaging scan might be recommended to confirm the cause of your pain..
Some patients have already done scans with other doctors for their pain condition but are still not clearly told what they suffer from.
Dr Terence Tan is happy to offer you a second opinion and recommend how best to manage your condition.
We also see patients who already have a confirmed diagnosis from specialist pain doctors, but are "stuck” because treatment options offered are not practical or acceptable.
We can help by discussing options that you might have potentially never been told of.
A common experience is when a patient has already consulted a specialist doctor for pain management and is told to consider orthopaedic surgery which they find too aggressive.
Or they may have seen doctors for their pain and were prescribed painkillers with potential side effects which made them feel uncomfortable.
Many of our patients have also first tried complementary treatments or acupuncture with traditional Chinese pain doctors.
They look for a second opinion after finding any relief experienced from other treatments to be temporary or requiring repetitive treatments, which add up to time and cost.
Especially in such situations, we emphasize using non-invasive medical technology you likely have not been told about .
This can make a big difference to your results.
Ask Dr Tan a Question about your problem
Find out how your pain can be more effectively treated.
For enquiries, Call +65 6732 2397
THE PAIN RELIEF CLINIC
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Singaporeans, permanent residents, and some international patients may be eligible for cashless services.
This can remove the need to pay cash upfront, solving a potential problem even for patients with insurance coverage.
You should be focused on getting answers and starting correct treatment, not worrying about large upfront bills.
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