What is a Rotator Cuff Tear?
A rotator cuff tear is a common cause of shoulder pain and disability among adults. Each year, almost 2 million people in the United States visit their doctors because of rotator cuff tears. A torn rotator cuff may weaken your shoulder. This means that many daily activities, like combing your hair or getting dressed, may become painful and difficult to do.
There are different types of tears.
- Partial tear: This type of tear does not completely detach the tendon from the bone. It is called partial because the tear goes only partially through the thickness of the tendon. The tendon is still attached to the bone, but it is thinned.
- Full-thickness tear: With this type of tear, there is detachment of part of the tendon from the bone. When only a small part of the tendon is detached from the bone, it is referred to as a full-thickness incomplete tear. When a tendon is completely detached from the bone, it is referred to as a full-thickness complete tear. With a full-thickness complete tear, there is basically a hole in the tendon.
Causes of Rotator Cuff Injury and Tear
Most tears are the result of a wearing down of the tendon that occurs slowly over time. This degeneration naturally occurs as we age and in most cases is relatively painless.
Rotator cuff tears are more common in the dominant arm — the arm you prefer to use for most tasks. If you have a degenerative tear in one shoulder, there is a greater likelihood of a rotator cuff tear in the opposite shoulder — even if you have no pain in that shoulder.
The most common rotator cuff injuries include:
- Overuse syndrome
- Shoulder impingement syndrome (rotator cuff tendinitis)
- Acute Rotator cuff tears (broken collarbone, a dislocated shoulder, or a wrist fracture)
- Shoulder sprains
- Swimmer’s shoulder
Risk Factors
Because most rotator cuff tears are largely caused by the normal wear and tear that goes along with aging, people over 40 are at greater risk
People who do repetitive lifting or overhead activities are also at risk for rotator cuff tears. Athletes are especially vulnerable to overuse tears, particularly tennis players and baseball pitchers. Painters, carpenters, and others who do overhead work also have a greater chance for tears. Although overuse tears caused by sports activity or overhead work also occur in younger people, most tears in young adults are caused by a traumatic injury, like a fall.
The following factors may increase the risk of having a rotator cuff injury:
Age: The risk of a rotator cuff injury increases with age. Rotator cuff tears are most common in people older than 60.
Some occupations: Jobs that require repetitive overhead arm motions, such as carpentry or house painting, can damage the rotator cuff over time.
Certain sports: Some types of rotator cuff injuries are more common in people who participate in sports like baseball, tennis and weight-lifting.
Family history: There may be a genetic component involved with rotator cuff injuries as they appear to occur more commonly in certain families.
Symptoms of Rotator Cuff Injury
You may not have any symptoms. However, if you do, the symptoms may gradually develop and worsen over time. The common symptom of cervical stenosis is mild to intense neck pain. Other symptoms include:
- Dull ache deep in the shoulder
- Difficulty combing your hair or reach behind your back
- Pain at rest and at night, particularly if lying on the affected shoulder
- Pain when lifting and lowering your arm or with specific movements
- Weakness when lifting or rotating your arm
- Crepitus, or a crackling sensation, when moving your shoulder in certain positions
Prognosis of Rotator Cuff Injury
Without treatment, rotator cuff problems may lead to permanent loss of motion or weakness of the shoulder joint.
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.
Diagnosis of Rotator Cuff Injury
Your orthopaedic surgeon will evaluate your medical history and may conduct a variety of tests to determine if you have a Rotator Cuff Injury:
X-rays: Although a rotator cuff tear won’t show up on an X-ray, this test can visualize bone spurs or other potential causes for your pain — such as arthritis.
Ultrasound: This type of test uses sound waves to produce images of structures within your body, particularly soft tissues such as muscles and tendons. It allows a provider to assess the structures of your shoulder during movement. It also allows a quick comparison between the affected shoulder and the healthy shoulder.
Magnetic resonance imaging (MRI): This technology uses radio waves and a strong magnet. The images obtained display all structures of the shoulder in great detail.
Pain Medicine Intervention
Pain associated with rotator cuff injury and tears come in through conservative treatment including:
Medications: Such as nonsteroidal anti-inflammatory drugs (NSAIDs) or muscle relaxants for pain management.
Physical Therapy: Physical therapy exercises can improve flexibility and strength of the muscles surrounding the shoulder joint. For many people with rotator cuff problems, these exercises are all that’s needed to manage their symptoms.
Epidural Steroid Injections: A steroid injection into the shoulder joint might be helpful, especially if the pain is interfering with sleep, daily activities or physical therapy. While such shots often provide temporary relief, they also can weaken the tendon and reduce the success of future shoulder surgery.
Lifestyle and home remedies: The pain from a minor rotator cuff injury often diminishes on its own, with proper care. Stop doing what caused the pain and try to avoid painful movements. Limit heavy lifting or overhead activity until the shoulder pain subsides. Icing the shoulder may help it feel better. Over-the-counter pain relievers such as ibuprofen (Advil, Motrin IB, others) or acetaminophen (Tylenol, others) also may be helpful.
Rest: Rest and avoiding the physical activity that caused the injury.
Ice: Your provider will tell you how often (and for how long) you should ice your shoulder. Wrap ice packs in a thin towel to avoid putting them directly on your skin.
Treatment of Rotator Cuff Injury
When conservative measures are ineffective or symptoms worsen, surgery may be considered:
Arthroscopic tendon repair: In this procedure, surgeons insert a tiny camera (arthroscope) and tools through small incisions to reattach the torn tendon to the bone.
Open tendon repair: In some situations, an open tendon repair may be a better option. In these types of surgeries, your surgeon works through a larger incision to reattach the damaged tendon to the bone.
Tendon transfer: If the torn tendon is too damaged to be reattached to the arm bone, surgeons may decide to use a nearby tendon as a replacement.
Shoulder replacement: Massive rotator cuff injuries may require shoulder replacement surgery. To improve the artificial joint’s stability, an innovative procedure (reverse shoulder arthroplasty) installs the ball part of the artificial joint onto the shoulder blade and the socket part onto the arm bone.
Procedure Videos
Steroid injection
References:
- “MRI of Torn Rotator Cuff.” Mayo Clinic, https://www.mayoclinic.org/diseases-conditions/rotator-cuff-injury/multimedia/mri-of-torn-rotator-cuff/img-20130558. Accessed 27 June 2024.
- Rotator cuff. Cleveland Clinic. https://my.clevelandclinic.org/health/body/rotator-cuff. Accessed June 27, 2024.
- Rotator cuff injury: Diagnosis & treatment. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/rotator-cuff-injury/diagnosis-treatment/drc-20350231. Accessed June 27, 2024.
- Rotator cuff injury. Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/rotator-cuff-injury. Accessed June 27, 2024.
- Rotator cuff tears. OrthoInfo – American Academy of Orthopaedic Surgeons. https://orthoinfo.aaos.org/en/diseases–conditions/rotator-cuff-tears/. Accessed June 27, 2024.