Partial Muscle Tears in the Shoulder: Diagnosis, Treatment, and Rehabilitation Process

The shoulder joint is one of the most mobile joints in the body, allowing for a wide range of movements, from daily activities to sports. However, this high mobility also makes the shoulder joint susceptible to injuries. Shoulder muscle tears, particularly involving the rotator cuff muscles, are common injuries. In this article, I will comprehensively discuss partial muscle tears in the shoulder, including their diagnosis, treatment, and rehabilitation process.

What Are Partial Muscle Tears?

Partial muscle tears refer to the partial rupture of muscle fibers in the shoulder without a complete tear. These injuries most commonly affect the rotator cuff muscles, particularly the supraspinatus muscle. The tear may present as small disruptions in the muscle fibers, leading to pain, restricted movement, and muscle weakness in the affected shoulder.

Partial tears generally occur due to acute trauma, repetitive overuse, or degenerative changes associated with aging. They are particularly common in athletes, individuals lifting heavy weights, and those who perform repetitive overhead movements.

Causes of Partial Shoulder Muscle Tears

The primary causes of partial shoulder muscle tears include:

• Traumatic Injuries: Direct impact to the shoulder or excessive strain from sudden movements can lead to muscle tears.
• Repetitive Microtraumas: Continuous repetitive movements, such as those performed by swimmers, tennis players, or weightlifters, can cause gradual wear and tear on muscle fibers, leading to partial tears.
• Aging and Degenerative Processes: As individuals age, muscle and tendon structures weaken, increasing the risk of tears.
• Postural Imbalances: Poor posture and muscle imbalances in the shoulder girdle can create excessive strain on the rotator cuff muscles.
• Poor Blood Supply to the Shoulder: The supraspinatus tendon has a limited blood supply, which can hinder healing and increase the likelihood of tears.

Symptoms

Partial muscle tears in the shoulder typically present with the following symptoms:

• Pain that worsens with specific movements
• Nighttime pain, making it difficult to sleep on the affected side
• Restricted range of motion and pain with certain movements
• Shoulder weakness
• Mechanical symptoms such as clicking, popping, or a catching sensation

Diagnostic Methods

Diagnosing partial muscle tears involves a clinical examination and imaging techniques:

• Physical Examination: We assess the patient's complaints, pain location, and severity. Special orthopedic tests (Jobe test, Neer impingement test, Hawkins-Kennedy test) help evaluate rotator cuff function.
• Magnetic Resonance Imaging (MRI): The most effective imaging method for assessing the tear's size, muscle tissue condition, and any accompanying injuries.
• Ultrasound: A quick, non-invasive, and dynamic assessment tool for evaluating muscle tears in real-time.

Treatment Options

The treatment approach depends on the size of the tear, the patient's age, activity level, and symptom severity.

Conservative (Non-Surgical) Treatment

Most partial muscle tears respond well to non-surgical treatment, which includes:

1. Rest and Activity Modification: Avoiding movements that worsen pain and limiting excessive use of the shoulder.
2. Physical Therapy and Rehabilitation: Prescribing exercises to maintain range of motion and strengthen shoulder muscles, particularly the rotator cuff and scapular stabilizer muscles.
3. Pain Management:
   • Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
   • Cold therapy (applied in the first 48 hours during the acute phase)
   • Physical therapy modalities such as ultrasound, electrotherapy, and laser therapy
4. Joint Injections: In some cases, intra-articular injections help reduce inflammation and pain. These may include:
   • Corticosteroids
   • Prolotherapy
   • Platelet-Rich Plasma (PRP)
   • Serum-derived regenerative injections
   • Stem cell therapy
   • Exosome therapy

Shoulder Mobilization

Shoulder mobilization includes manual therapy techniques and exercises aimed at improving range of motion, enhancing flexibility, and reducing pain. These techniques are often applied by a manual therapist trained in orthopedic manual therapy and osteopathy.

Surgical Treatment

Surgery is considered for patients who do not respond to conservative treatment or have progressive or large partial tears. Surgical options include:

• Arthroscopic Debridement: Removing damaged tissue to reduce irritation.
• Surgical Repair: Stitching the torn muscle fibers together.
• More Extensive Repair: In severe cases, a more complex reconstructive procedure may be needed.

Rehabilitation Process

Rehabilitation plays a crucial role in the recovery of partial muscle tears. The process includes the following phases:

1. Initial Phase (Pain and Inflammation Reduction): The primary focus in the first few weeks is managing pain and preventing further damage.
2. Range of Motion Restoration: Implementing stretching and mobilization exercises to restore shoulder movement.
3. Muscle Strengthening: Gradually strengthening the rotator cuff and periscapular muscles.
4. Functional Return to Activity: For athletes or individuals with physically demanding jobs, we create a customized rehabilitation program to ensure full recovery.

Conclusion

If left untreated, partial muscle tears in the shoulder can lead to chronic pain and functional limitations. With an accurate diagnosis, personalized treatment plan, and structured rehabilitation, patients can achieve high recovery rates. As Physical Medicine and Rehabilitation specialists, our goal is to enhance patients' quality of life through tailored treatment programs designed for optimal healing and recovery.

Dr. Elif BERBER, PhD
Specialist in Physical Medicine and Rehabilitation