Q: Is it possible to tear the rotator cuff and not know it? I don't have any pain but my shoulder just doesn't work the way it should. I seem to recall injuring my arm years ago. Do you think I should see a doctor?

A: Shoulder pain or the lack of shoulder pain is not always a reliable symptom to indicate the status of the rotator cuff. Studies show that a significant number of older adults actually have a torn rotator cuff and don't know it. And shoulder pain can be caused by other problems other than a torn tendon (e.g., impingement, bone spurs, bursitis).

It would be a good idea to see your primary care physician or an orthopedic surgeon if you are experiencing a change in your shoulder (pain, loss of motion, loss of strength). In adults over the age of 50, degeneration is possible. In adults over 60, other diseases mimicking shoulder pain could be present (e.g., heart disease, bleeding ulcers, kidney disease).

The physician will conduct a clinical exam, order lab work if needed, and perhaps request an X-ray. If there is a suspicion that the rotator cuff is torn, then an ultrasound can be done. Studies show that ultrasound imaging is actually a very reliable way to look for tendon tears. The images show tear location, size (length), and depth. This additional information helps the physician guide you through treatment.

Small tears may have a chance of healing. With a rehab program, it is possible to strengthen other muscle fibers to help protect the torn tendon. Larger tears are more likely to get even bigger and cause problems. Your participation in recreational or sports activities or even loss of balance and a fall can put you at risk for further injury that might require surgery to repair the damage.

All of this is just speculation without a proper examination and diagnosis. Make an appointment with your physician to be sure. Many times, an early diagnosis and treatment can prevent worse problems. It certainly will put any concerns you have to rest.

Reference: Rainer Kluger, MD,et al. Long-Term Survivorship of Rotator Cuff Repairs Using Ultrasound and Magnetic Resonance Imaging Analysis. In The American Journal of Sports Medicine. October 2011. Vol. 39. No. 10. Pp. 2071-2081.