What makes a torn tendon worse?

Tendonitis

It can cause joint pain, stiffness, and affect how a tendon moves.

You can treat mild tendon injuries yourself and should feel better within 2 to 3 weeks.

How to treat tendonitis yourself

Follow these steps for 2 to 3 days to help manage pain and to support the tendon.

• Rest: try to avoid moving the tendon for 2 to 3 days.
• Ice: put an ice pack (or try a bag of frozen peas wrapped in a tea towel) on the tendon for up to 20 minutes every 2 to 3 hours.
• Support: wrap an elastic bandage around the area, use a tube bandage, or use a soft brace. You can buy these from pharmacies. It should be snug, not tight.

It’s important to take a bandage or brace off before going to bed.

When you can move the injured area without pain stopping you, try to keep moving it so the joint does not become stiff.

To help prevent further injury or pain, try to avoid:

• heavy lifting, strong gripping or twisting actions that make the symptoms worse
• playing sports, until the tendon has recovered

A pharmacist may help with tendonitis

A pharmacist can recommend the best painkiller for you. Paracetamol and ibuprofen can help to ease pain.

They may also recommend a nonsteroidal anti-inflammatory (NSAID) cream or gel you rub on your skin.

Symptoms of tendonitis

There are tendons all over your body. They connect your muscles to bones in your joints, for example, in your knees, elbows and shoulders.

The main symptoms of tendonitis are:

• pain in a tendon that gets worse when you move
• difficulty moving the joint
• feeling a grating or crackling sensation when you move the tendon
• swelling, sometimes with heat or redness

Non-urgent advice: Go to a minor injuries unit or see a GP if:

• your symptoms do not improve within a few weeks
• you’re in a lot of pain
• you think you have ruptured (torn) a tendon

If the pain is sudden and severe, and happened during an accident or activity, you may have ruptured a tendon. You might have heard a popping or snapping sound when the pain started.

If your tendon is ruptured, you may be referred to a specialist for assessment.

You may be referred to hospital for an X-ray or scan if your doctor thinks you may have another injury, such as a broken bone.

Treatment for tendonitis from a GP

A GP may prescribe a stronger painkiller or suggest you use a NSAID cream or gel on your skin to ease pain.

If the pain is severe, lasts a long time, or your movement is limited, you may be referred for physiotherapy. You can also choose to book appointments privately.

If physiotherapy does not help, you may be referred to a doctor who specialises in muscles and bones (orthopaedic specialist) or a local musculoskeletal clinic.

Some people with severe tendonitis may be offered:

• steroid injections, which may provide short-term pain relief (this cannot be offered for problems with the achilles tendon)
• shockwave therapy, which may help with healing
• platelet rich plasma injections (PRP), which may help with healing
• surgery to remove damaged tissue or repair a ruptured tendon

Preventing tendon problems

Tendonitis is usually caused by sudden, sharp movements or repetitive exercise, such as running, jumping or throwing.

Tendonitis can also be caused by repetitive movements, or having poor posture or technique while at work or when playing a sport. This is known as repetitive strain injury (RSI).

You cannot always prevent tendonitis. But there are things you can do to help reduce the chance of a tendon injury.

Tendon Injury (Tendinopathy)

Tendons are the tough fibers that connect muscle to bone. A tendon injury (tendinopathy) occurs when you have irritated or damaged these fibers. The areas most often affected are the shoulder, elbow, wrist, hip, knee, and ankle.

What causes it?

Most tendon injuries are the result of gradual wear and tear to the tendon from overuse or aging. They are more likely in people who make the same motions over and over in their jobs, sports, or daily activities. A tendon injury can happen suddenly or little by little.

What are the symptoms?

Tendinopathy usually causes pain, stiffness, and loss of strength in the affected area. The area may be tender, red, warm, or swollen. The pain may get worse when you use the tendon, and you may have more pain and stiffness during the night or when you get up in the morning.

How is it diagnosed?

Your doctor will ask about your past health and your symptoms and will do a physical exam. The doctor will check for pain, tenderness, range of motion, and strength. You may be asked to show the doctor how you use tools or sports equipment.

How is a tendon injury treated?

Treatment most often starts with home care, including rest, ice, and over-the-counter pain medicines. Your doctor may also suggest physical therapy. For a severe or long-lasting injury, your doctor may prescribe a brace, a splint, a sling, or crutches to allow tendons to rest and heal.

Cause

Most tendinopathy is the result of gradual wear and tear to the tendon from overuse or aging. Anyone can have a tendon injury. But people who make the same motions over and over in their jobs, sports, or daily activities are more likely to damage a tendon.

A tendon injury can happen suddenly or little by little. You are more likely to have a sudden injury if the tendon has been weakened over time.

Learn more

• Calcium Deposits and Tendinitis (Calcific Tendinitis)

Prevention

To keep from hurting your tendon again, you may need to make some long-term changes to your activities.

• Try changing what activities you do or how you do them. For example, if running caused the injury, try swimming some days. If the way you use a tool is the problem, try switching hands or changing your grip.
• If exercise caused the problem, take lessons or ask a trainer or pro to check your technique.
• If your job caused the tendon injury, ask your human resources department if there are other ways to do your job.
• Always take time to warm up before and stretch after you exercise.

Symptoms

Symptoms of tendinopathy can include:

• Pain, tenderness, redness, warmth, and swelling near the injured tendon. Pain may get worse when you’re active. Symptoms may affect just the spot where the injured tendon is located, or they may be spread out from the joint area.
• Crepitus, or a crunchy sound or feeling when the tendon is used. This is usually uncomfortable or painful.
• Pain and stiffness that may be worse during the night or when you get up in the morning.
• Stiffness in the joint near the affected area. Movement or mild exercise of the joint usually reduces the stiffness.

A tendon injury typically gets worse if the tendon isn’t allowed to rest and heal. Too much movement may make your symptoms worse or bring the pain and stiffness back.

Exams and Tests

Your doctor will ask questions about your past health and your symptoms. You will also have a physical exam. During this exam, the doctor will check your overall health, any areas of pain and tenderness, and your range of motion and strength. Your exam may also include checking your nerve function (feeling and reflexes) and blood circulation (pulses).

If the injury is related to your use of a tool or sports equipment, the doctor may ask you to show how you use it.

If your symptoms are severe or don’t improve with treatment, your doctor may want you to have a test.

• An X-ray can show any bone-related problems or bits of calcium in tendons or joint structures.
• An MRI can show small tears and areas of tendon, ligament, cartilage, and muscle injury.
• An ultrasound can show thickening, swelling, or tears in soft tissues such as the bursae and tendons.

Learn more

• Extremity X-Ray
• Magnetic Resonance Imaging (MRI)
• Ultrasound

Treatment Overview

Treatment most often starts with home care, including rest, ice, and over-the-counter pain medicines. If these steps don’t help to relieve pain, your doctor may:

• Prescribe physical therapy.
• Use a steroid shot to relieve pain and swelling. This treatment usually isn’t repeated because it can damage the tendon.
• Prescribe a brace, a splint, a sling, or crutches for a short time to allow tendons to rest and heal.
• Recommend a cast to rest and heal a badly damaged tendon. Casting or surgery is often used to treat a ruptured tendon.

Learn more

• Acetaminophen
• Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
• Physical Therapy

Self-Care

Caring for yourself when you have a tendon injury means doing things that will help your tendon heal. Here are some steps you can take.

• Rest the affected area. Avoid any activity that may cause pain. And be sure to get enough sleep. To keep your overall health and fitness, keep exercising. But do it only in ways that don’t stress the affected area. Don’t restart a pain-causing activity as soon as your pain stops. Tendons require weeks of extra rest to heal. You may need to make long-term changes in the types of activities you do or how you do them.
• Apply ice or cold packs to the affected area. Do this as soon as you notice pain and tenderness in your muscles or near a joint. Apply ice 10 to 15 minutes at a time, as often as twice an hour, for 72 hours. Keep applying ice (15 to 20 minutes at a time, 3 times a day) as long as it relieves pain. Although heating pads may feel good, ice will relieve pain and inflammation.
• Take pain relievers. Use acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, as directed for pain relief. NSAIDs also reduce any inflammation you might have in or around the tendon (tendinitis). NSAIDs come in pills and in a cream that you rub over the sore area. Don’t rely on medicine to relieve pain in order to keep overusing a joint.
• Do range-of-motion exercises each day. Gently move your joint through its full range of motion as directed by your doctor or physical therapist. Do this even during the time that you are resting the joint area. It will prevent stiffness in your joint. As the pain goes away, keep doing range-of-motion exercises , and add other exercises to strengthen the muscles around your joint.
• Gradually resume your activity. Do it at a lower intensity than you were doing before your symptoms began. Warm up before and stretch after the activity. Increase your activity slowly, and stop if it hurts. After the activity, apply ice to prevent pain and swelling. You can also make some changes. For example, if exercise has caused your tendon injury, try alternating with another activity. If using a tool is the problem, try switching hands or changing your grip.
• Don’t smoke. Tendon injuries heal more slowly in smokers than in nonsmokers. Smoking delays wound and tissue healing.

Learn more

• Elbow Bursitis and Tendon Injury: Preventing Pain
• Heel Bursitis or Tendon Injury: Preventing Pain
• Hip Bursitis or Tendon Injury: Preventing Pain
• Knee Bursitis and Tendon Injury: Preventing Pain
• Quitting Smoking
• Shoulder Bursitis and Tendon Injury: Preventing Pain
• Using Cold and Heat Therapies
• Wrist Tendon Injury: Preventing Pain

Related Information

• Achilles Tendon Problems
• Bursitis
• Hip Problems, Age 12 and Older
• Knee Problems and Injuries
• Rotator Cuff Disorders
• Tennis Elbow

Rotator Cuff Tears

A partial or complete rotator cuff tear makes it difficult to raise and move your arm. You may have shoulder pain and arm weakness. Rotator cuff injuries are common, especially as you get older. Rest, pain relievers and physical therapy can help. Some people need surgery to reattach a torn rotator cuff.

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Overview

What is the rotator cuff?

The rotator cuff is a group of muscles and tendons in your shoulder. They help you lift and move your arms away from your body. The rotator cuff keeps the ball of the upper arm bone (humerus) in the shoulder blade socket.

What is a rotator cuff tear?

The shoulder is a ball-and-socket joint that’s part of the skeletal system. It’s like a golf ball sitting on a golf tee. Rotator cuff tears occur when tendons pull away from the arm bone. A tear may result from overuse or another injury.

What are the types of rotator cuff tears?

Types of torn rotator cuffs include:

• Partial: With an incomplete or partial tear, the tendon still somewhat attaches to the arm bone.
• Complete: With a full-thickness or complete tear, the tendon separates completely from the bone. There’s a hole or rip in the tendon.

How common are rotator cuff tears?

More than two million Americans experience some type of rotator cuff problem every year. Rotator cuff tears affect people of all ages and genders, but the problem is more common in adults.

Symptoms and Causes

What causes a rotator cuff tear?

An accident, such as a fall, can cause a broken collarbone or dislocated shoulder that tears the rotator cuff.

More commonly, rotator cuff tears occur over time as the tendon wears down with age and use (degenerative tear). People over 40 are most at risk.

Causes of degenerative tears include:

• Bone spurs: Bony growths can form on the top of the shoulder bone. These bone spurs rub against the tendon when you lift your arm. This shoulder impingement creates friction between the bone and tendon. Eventually, a partial or complete tear may occur.
• Decreased blood flow: Blood flow to the rotator cuff decreases as you get older. Your muscles and tendons need a healthy blood supply to repair themselves. If blood doesn’t nourish the tendons, they can tear.
• Overuse: Repetitive shoulder movements during sports or on the job can stress muscles and tendons, causing a tear.

What are risk factors for rotator cuff tears?

Anyone can experience a rotator cuff tear. These factors may increase your risk:

• Family history of shoulder problems or rotator cuff injuries.
• Poor posture.
• Smoking.
• Being age 40 or older.

Degenerative tears are more common among people who do the same repetitive shoulder movements, such as:

• Carpenters.
• Mechanics.
• Painters.
• Recreational and professional athletes who play baseball, softball and tennis or are part of a rowing crew.

Do rotator cuff tears affect both shoulders?

Tears tend to occur on your dominant side, but can be on either side. Having a tear in one shoulder increases the likelihood of a tear in the opposite shoulder. You might not have shoulder pain on the opposite side, but tests may indicate a tear. The opposite may also be true: you may have a tear but have no pain or symptoms.

What are the symptoms of a rotator cuff tear?

Sudden tears from accidents cause immediate, intense shoulder pain and arm weakness. With degenerative tears, you may have mild pain that improves with over-the-counter pain relievers. Over time, the pain gets worse, and pain relievers don’t help. Not everyone has pain, but most people have some degree of arm and shoulder weakness.

Signs of a rotator cuff tear include:

• Difficulty and pain caused by raising your arm.
• Popping or clicking sounds or sensations when moving your arm.
• Shoulder pain that worsens at night or when resting your arm.
• Shoulder weakness and struggling to lift items.

Diagnosis and Tests

How is a rotator cuff tear diagnosed?

Your healthcare provider will perform a physical exam to check for shoulder tenderness, range of motion and arm strength.

To confirm a diagnosis, you may get:

Management and Treatment

What are the complications of a rotator cuff tear?

A rotator cuff tear can get worse without treatment. A complete tear can make it almost impossible to move your arm. Without treatment, you may have chronic shoulder pain and find it very difficult to use the injured arm.

What are nonsurgical treatments for rotator cuff tears?

Rotator cuff tears do not heal on their own without surgery, but many patients can improve functionally and decrease pain with nonsurgical treatment by strengthening their shoulder muscles. Just because there is a tear, does not necessarily mean a surgery is needed. About eight out of 10 people with partial tears get better with nonsurgical treatments. It can take up to a year for the condition to improve.

Nonsurgical treatments include:

• An arm sling and rest to give your shoulder time to heal. You may need to modify activities and stop certain work or sports for a period of time.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) to minimize pain and swelling.
• Physical therapy to learn strengthening and stretching exercises.
• Steroid injections to ease pain and swelling.

What are the surgical treatments for rotator cuff tears?

Your healthcare provider may recommend surgery if you have a complete tear or nonsurgical treatments don’t help a partial tear. You may also have surgery if your job or athletic interests affect the shoulder.

Most rotator cuff surgeries take place arthroscopically through small incisions. The surgery is an outpatient procedure. You go home the same day, but the overall recovery after this surgery is very substantial and can take up to a year or more.

Some tears are not repairable due to the size and/or age of the tear, and may necessitate reverse shoulder replacement, tendon transfer, or a debridement of scar tissue without repair.

During surgery, your healthcare provider:

• Inserts an arthroscope (small camera) through a small incision in your shoulder.
• Refers to images from the arthroscope to perform the procedure.
• Inserts tiny instruments into small incisions in your shoulder to remove bone spurs and reattach the tendon to the upper arm bone.

For a partial tear, your healthcare provider may only need to trim fraying pieces of a partially torn tendon. This debridement procedure keeps the shoulder ball and socket from catching on the tendon and tearing it more.

After surgery, you need to wear a sling to immobilize your arm for four to six weeks. You can then start physical therapy. Most people regain shoulder function and strength within four to six months after surgery, but full recovery may take up to 12-18 months.

Prevention

How can I prevent a rotator cuff tear?

To prevent a rotator cuff tear, it’s important to keep your muscles and tendons flexible. Your healthcare provider can teach you stretching and strengthening exercises to do at home.

Outlook / Prognosis

What is the prognosis (outlook) for people who have a rotator cuff tear?

Most people see improvements with nonsurgical treatments. Recovery takes time because your body needs time to heal. Most people who have surgery to repair a torn rotator cuff regain function.

It’s possible to tear the same tendon again, especially if the first tear was bigger than 1 inch. A re-tear that causes severe pain or loss of movement may require surgery.

Living With

When should I call my healthcare provider?

You should call your healthcare provider if you experience:

• Chronic shoulder and arm pain.
• Pain that worsens at night or interferes with sleep.
• Redness, swelling, or tenderness in the shoulder joint area.
• Shoulder or arm weakness.

What questions should I ask my healthcare provider?

You may want to ask your healthcare provider:

• What caused the rotator cuff tear?
• What is the best treatment for me?
• What can I do to lower the risk of getting another rotator cuff tear?
• Should I look out for signs of complications?
• Which signs of complications?

A note from Cleveland Clinic

If you work a very physical job or you’re an athlete, a rotator cuff injury will likely bench you, but it doesn’t have to be the end of your career. Talk to your healthcare provider about the best treatment options, whether nonsurgical or surgical. Your shoulder may be weak and painful for a while, but it will eventually heal.

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Last reviewed by a Cleveland Clinic medical professional on 01/28/2021.

References

• American Academy of Orthopaedic Surgeons. Common Shoulder Injuries. (https://orthoinfo.aaos.org/en/diseases—conditions/common-shoulder-injuries/) Accessed 1/28/2021.
• American Academy of Orthopaedic Surgeons. Rotator Cuff Tears. (https://orthoinfo.aaos.org/en/diseases—conditions/rotator-cuff-tears/) Accessed 1/28/2021.
• American Academy of Orthopaedic Surgeons. Rotator Cuff Tears: Surgical Treatment Options. (https://orthoinfo.aaos.org/en/treatment/rotator-cuff-tears-surgical-treatment-options/) Accessed 1/28/2021.
• American Academy of Orthopaedic Surgeons. Shoulder Impingement/Rotator Cuff Tendinitis. (https://orthoinfo.aaos.org/en/diseases—conditions/shoulder-impingementrotator-cuff-tendinitis/) Accessed 1/28/2021.
• May T, Garmel GM. Rotator Cuff Injury. (https://www.ncbi.nlm.nih.gov/books/NBK547664/) StatPearls (Internet). Accessed 1/28/2021.
• Merck Manual. Rotator Cuff Injury/Subacromial Bursitis. (https://www.merckmanuals.com/home/injuries-and-poisoning/sports-injuries/rotator-cuff-injury-subacromial-bursitis) Accessed 1/28/2021.
• Pandey V, Willems WJ. Rotator cuff tear: A detailed update. Asia Pacific Journal of Sports Medicine, Arthroscopy, Rehabilitation and Technology. 2015;2(1):1-14. Accessed 1/28/2021.
• OrthoInfo. Rotator Cuff Tears. (https://orthoinfo.aaos.org/en/diseases—conditions/rotator-cuff-tears/) Accessed 1/28/2021.
• OrthoInfo. Rotator Cuff Tears: Surgical Treatment Options. (https://orthoinfo.aaos.org/en/treatment/rotator-cuff-tears-surgical-treatment-options/) Accessed 1/28/2021.