Rotator Cuff Tears

Overview

The rotator cuff is a group of muscles and tendons that surround the shoulder joint and help to keep the upper arm bone securely in the shoulder socket. A rotator cuff tear occurs when one or more of these tendons tear, either partially or completely. This can happen as a result of an injury or from overuse, especially in athletes who engage in repetitive overhead motions. Rotator cuff tears can cause pain, weakness, and limited range of motion in the shoulder. Depending on the severity of the tear, treatment may range from physical therapy and rest to surgical repair.

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.

Types of Rotator Cuff Tear

When one or more tendons of the rotator cuff are torn, they can partially or completely detach from the head of the humerus. The supraspinatus tendon is the most commonly affected tendon, but other parts of the rotator cuff can also be damaged. Torn tendons usually begin to fray and gradually worsen over time, with complete detachment sometimes occurring when lifting heavy objects. There are different types of tears, including partial tears, which do not completely detach the tendon from the bone, and full-thickness tears, which involve detachment of part or all of the tendon from the bone. Full-thickness tears can be further classified as either incomplete or complete tears, with complete tears resulting in a hole in the tendon.

Symptoms of Rotator Cuff Tear

Symptoms of rotator cuff tears can include:

Pain in the shoulder, which can be constant or occur with certain movements
Weakness in the shoulder, making it difficult to lift or rotate the arm
Decreased range of motion in the shoulder
A clicking or popping sound when moving the shoulder
Difficulty sleeping on the affected shoulder

In some cases, there may be no symptoms at all, especially with partial tears. It is important to note that these symptoms can also be caused by other shoulder conditions, and a proper diagnosis by a healthcare professional is necessary.

Causes of Rotator Cuff Tear

The rotator cuff tendons can tear as a result of acute injuries or degenerative changes over time. Acute tears may result from a fall on an outstretched arm, a direct blow to the shoulder, or lifting a heavy object. Degenerative tears are more common and are a result of the aging process or chronic overuse. Repetitive overhead motions, such as those performed by painters, carpenters, and athletes, can cause degenerative tears. Other factors that may contribute to rotator cuff tears include genetics, poor posture, and shoulder impingement. Certain medical conditions, such as diabetes and thyroid disease, may also increase the risk of rotator cuff tears.

Diagnostics of Rotator Cuff Tear

Rotator cuff tears can be diagnosed through a combination of physical examination, medical history, and imaging tests. The doctor will begin by asking about the patient’s symptoms and how the injury occurred. During a physical examination, the doctor will check the shoulder for pain, swelling, weakness, and limited range of motion. The doctor may also perform specific tests to evaluate the rotator cuff’s function, such as the drop-arm test or the lift-off test.

Imaging tests, such as X-rays, ultrasound, and MRI, may be ordered to confirm the diagnosis and assess the extent of the injury. X-rays can show any bone spurs or other bony abnormalities that may have contributed to the tear, while ultrasound and MRI can provide more detailed images of the soft tissue structures in the shoulder.

Complications of Rotator Cuff Tear

Complications of rotator cuff tears depend on the severity of the tear, age, and overall health of the individual. Some of the possible complications include:

Pain and weakness: Pain and weakness are common symptoms of rotator cuff tears, which can affect daily activities and quality of life.
Limited range of motion: A torn rotator cuff can limit the range of motion of the shoulder joint, making it difficult to perform simple tasks like reaching for objects.
Muscle atrophy: Long-standing rotator cuff tears can cause the muscles around the shoulder to weaken and shrink due to disuse.
Tendon retraction: Severe rotator cuff tears can cause the tendon to retract, or pull away from the bone. This can make it difficult to reattach the tendon to the bone and may require more complex surgical procedures.
Frozen shoulder: A rotator cuff tear can cause adhesive capsulitis, also known as frozen shoulder, where the shoulder joint becomes stiff and difficult to move.
Arthritis: Over time, untreated rotator cuff tears can cause arthritis in the shoulder joint.
Rotator cuff tear arthropathy: In rare cases, chronic rotator cuff tears can cause a condition known as rotator cuff tear arthropathy, which is characterized by severe joint pain and disability.

Treatment of Rotator Cuff Tear

Continuing to use a shoulder with a rotator cuff tear despite increasing pain may lead to further damage and enlargement of the tear. It’s important to see a doctor if you experience chronic shoulder and arm pain. Early treatment can prevent the symptoms from getting worse and help you recover more quickly.

The goal of any treatment for a rotator cuff tear is to reduce pain and restore function. The best treatment option depends on various factors, such as age, activity level, general health, and the type of tear. Surgery is not always necessary and nonsurgical treatments are often recommended first, such as rest, activity modification, anti-inflammatory drugs, physical therapy, and steroid injections.

Nonsurgical treatment can provide relief for around 80 to 85% of patients, and it avoids the risks associated with surgery, such as infection, permanent stiffness, anesthesia complications, and lengthy recovery time. However, the disadvantages of nonsurgical treatment are that the tear may increase in size over time, and patients may need to limit activities.

Surgery may be recommended if pain does not improve with nonsurgical methods, or if there are signs of significant weakness and loss of function, a large tear, or recent acute injury. The surgical procedure involves re-attaching the tendon to the upper arm bone, and the best approach will depend on the individual’s specific health needs. The typical surgical approach for a torn rotator cuff is to reattach the tendon to the head of the humerus. In some cases, such as with a partial tear, a debridement procedure may be enough to smooth or trim the affected area. For a complete tear, the tendon is stitched back to its original location on the humerus.