Hurt Your Shoulder in an Accident? Here's How to Tell If It's Serious

A shoulder "strain" and a rotator cuff "tear" can feel similar at first. But one might heal in weeks, while the other could need surgery. And the difference in your settlement? Potentially $100,000 or more.

Is It a Strain or a Tear? Why That Matters So Much

After an accident, shoulder pain is one of the most common complaints. But here's what most people don't realize: there's a huge difference between a shoulder "strain" and a rotator cuff "tear"—and that difference can be worth $100,000 or more in your settlement.

A strain means the muscles or tendons got stretched or slightly damaged, but they're still intact. It usually heals on its own in a few weeks with rest and maybe some physical therapy.

A tear means the tendon actually ripped—either partially or completely. This is structural damage. It often requires surgery, months of recovery, and may never fully heal.

The tricky part? Both can start with similar symptoms: pain, weakness, trouble lifting your arm. The only way to know for sure is with an MRI and evaluation by an orthopedic specialist.

If you have significant shoulder symptoms after an accident, don't let anyone tell you it's "just a strain" without proper imaging. That assumption could cost you tens of thousands of dollars.

How Do I Know If My Shoulder Is Torn?

Here are the signs that suggest you might have a tear rather than just a strain:

Signs pointing to a TEAR: - Sudden weakness—you try to lift your arm and it just won't go - You felt or heard a "pop" when the injury happened - Pain at night that wakes you up or keeps you from sleeping on that side - Weakness that doesn't get better even after resting - Your arm feels "dead" or heavy when you try to lift it

Signs more consistent with a STRAIN: - Pain, but you can still lift things if you push through - Gets noticeably better with rest - No night pain - You can move your arm through its full range (it just hurts) - Improves significantly within 2-4 weeks

Here's the bottom line: if you have weakness (not just pain), if you can't sleep on that side, or if your symptoms aren't improving after 2-3 weeks, you need an MRI. Don't settle for "take some ibuprofen and rest."

Why Does the Medical Code Matter for My Claim?

There are different codes doctors can use for shoulder injuries, and they mean different things to insurance companies:

S46.0 (Traumatic rotator cuff injury): This code specifically says your injury came from an accident. It's the strongest code for your claim because it establishes that the accident caused the damage.

M75.1 (Rotator cuff tear - general): This code just says you have a tear, but doesn't specify whether it came from an accident or just wore out over time. Insurance companies prefer this code because they can argue "maybe it was already like that."

S46.01 (Rotator cuff strain): This is for stretching without an actual tear. It's considered less serious and leads to lower settlement offers.

Here's what to watch for: if your MRI shows a tear, but your medical records only say "shoulder pain" or "strain," there's a mismatch. Your records should reflect what the imaging actually shows. If they don't, that's something to discuss with your doctor.

What If They Say My Shoulder Was Already Worn Out?

This is one of the most common arguments insurance companies make: "Your MRI shows some degeneration, so this isn't really from the accident."

Here's the truth: a lot of people have some wear and tear in their shoulders, especially after age 40. You might have had a rotator cuff that was a little worn but never caused you any problems. Then an accident comes along and turns that worn tendon into a torn tendon.

The legal principle here is called the "eggshell plaintiff" rule. It means that if you were more vulnerable to injury because of a pre-existing condition, the person who hurt you is still responsible for the full extent of your injuries. They take you as they find you.

So if your shoulder was fine before the accident—you weren't having pain, you could use it normally—and now you have a tear that needs surgery, the accident is responsible. It doesn't matter that your shoulder wasn't perfect to begin with.

What helps your case: documentation that you weren't having shoulder problems before the accident. Medical records showing no prior complaints. Statements from people who knew you before saying you used your shoulder normally.

What Makes a Shoulder Injury Claim Stronger?

Insurance companies look at specific things when evaluating shoulder claims. Here's what moves the needle:

MRI findings that matter: - "Full-thickness tear" means the tendon is completely torn through—this is the most serious - "Partial-thickness tear" means it's partially torn—still significant - "Retraction" means the tendon has pulled back from where it should be—indicates severity - Watch out for "tendinopathy" or "degenerative changes"—insurance will use these to argue pre-existing condition

Other factors that increase value: - You needed surgery (surgical cases are worth significantly more) - It's your dominant arm (affects your daily life more) - Your job requires physical use of your arm - You have documented permanent restrictions - The surgery didn't fully fix the problem

What insurance uses against you: - MRI mentions "degenerative changes" - It's your non-dominant arm - You have a desk job - You went back to normal activities quickly - Gaps in your treatment

The key is making sure your medical records tell the full story of your injury and how it's affected your life.

Injury Code Scanner

Select where it hurts to see potential ICD-10 codes in your medical records.

Understanding ICD-10 Code S46.0

S46.0 - Rotator cuff injury from trauma. This is the code doctors use when your rotator cuff (the muscles and tendons that hold your shoulder together) gets damaged in an accident. The key word here is "trauma"—this code specifically says the injury came from a specific event, not from wear and tear over time.

How much is a rotator cuff tear case worth?

It depends on the severity. Partial tears that don't require surgery typically settle for $25,000-$50,000. If you needed surgery, that range jumps to $75,000-$150,000. Complete tears requiring surgery with complications or poor outcomes can exceed $200,000. These are ranges we've observed—your case could be different.

Do I need surgery for a rotator cuff tear?

Not always. Some partial tears can heal with physical therapy and time. But complete tears usually need surgical repair, and even some partial tears don't heal well without surgery. An orthopedic specialist can tell you what's best for your specific situation. From a claim perspective, surgical cases are typically worth more because they involve more treatment, longer recovery, and often have lasting effects.

How long does it take to recover from rotator cuff surgery?

Full recovery typically takes 6-12 months. You'll be in a sling for the first 6 weeks, then start physical therapy. Most people don't reach their maximum improvement for 9-12 months. This long recovery period is one reason surgical shoulder cases have higher settlement values—you're dealing with the injury for a long time.

Can I get compensation if my shoulder had some wear and tear before the accident?

Yes. Many people have some rotator cuff degeneration without even knowing it—it never caused them problems. If the accident turned that asymptomatic wear into a painful, disabling tear, you're entitled to compensation. The legal principle is that the at-fault party takes you as they find you. If you were more vulnerable to injury, that's their problem, not yours.

The insurance company says my shoulder injury is "just soft tissue." Is that bad?

They're trying to minimize your injury. Yes, the rotator cuff is technically "soft tissue"—but so is your heart. A rotator cuff tear is a serious injury that can require surgery and months of recovery. Don't let the phrase "soft tissue" make you think your injury isn't significant. What matters is the specific diagnosis and how it's affected your life.

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