Rotator Cuff Tears
Rotator Cuff Tear
Every year, close to 2 million Americans visit a doctor for a problem with their rotator cuff, a group of four muscles that surrounds the shoulder joint, provides stability and allows pain-free movement. One of the most common problems that occur with this group of muscles is a rotator cuff tear. In this article, we discuss everything about rotator cuff tears, from causes to symptoms, risk factors, diagnosis, and treatment.
What is a Rotator Cuff Tear?
As noted, the rotator cuff consists of four muscles – the supraspinatus, infraspinatus, teres minor, and subscapularis. The tendons of these muscles are tough bands of fibrous tissue that connect the muscles to bone. When a rotator cuff tendon gets torn, the muscle no longer firmly connects to the humerus (upper arm bone). The most common muscle affected by rotator cuff tears is the supraspinatus, but other muscles can also be affected. Oftentimes, the damage starts with fraying of the tendon and, over time, progresses to a complete tear.
Types of Rotator Cuff Tears
There are two types of rotator cuff tears. An incomplete or partial-thickness tear is when the tendon is damaged or frayed but has not completely severed from its attachment to the bone. A complete or full-thickness rotator cuff tear is when the tendon breaks off or separates fully from the bone.
Dan Orcutt, MD discusses the two most common ways rotator cuff injuries occur.
Causes of Rotator Cuff Tears
The two primary reasons for tears to develop in the rotator cuff tendons are injury (trauma) and degeneration (wear and tear). If a person lifts a heavy object with a jerk or falls on an outstretched arm, it can lead to a rotator cuff tear. In such cases, the tear in the rotator cuff tendon may be associated with other injuries, for example, a fracture of the collarbone or a dislocation of the shoulder joint.
More often, a rotator cuff tear occurs due to gradual wear and tear of the tendons. This is a normal degenerative process that occurs with age. Degenerative tears in the rotator cuff occur more often in the dominant arm and can be the result of various things such as:
Risk factors for rotator cuff tears
Age
With age, wear and tear of the tendons can lead to rotator cuff tears. Tears occur most often in those over 40.
Occupation
Jobs that require repeated overhead activities or lifting increase the risk of rotator cuff tears. Examples include carpenters, painters, and linesmen.
Sports and hobbies
Athletes, especially baseball pitchers, tennis players, and weightlifters, are vulnerable to rotator cuff tears due to overuse.
Read on to learn more
Symptoms of Rotator Cuff Tear
In many people, a rotator cuff tear does not cause any symptoms. They remain unaware that they have a problem with their shoulder. However, in about one-third of patients, a rotator cuff tear is symptomatic. The most common symptoms of a rotator cuff tear are:
- Pain at rest
- Pain with specific movements such as lifting the arm
- Pain at night, particularly when lying on the affected shoulder
- Weakness with rotating or lifting the arm
- A crackling sensation in the joint in certain positions
Rotator cuff tears that occur as a result of acute injuries typically cause intense pain immediately following the event. This is often associated with a sensation of snapping and almost immediate weakness in the rotator cuff muscles. Tears in the rotator cuff that occur due to age or overuse tend to develop more
insidiously. At first, the pain may be mild, only present with certain movements, and relieved with pain medications. With time, the pain may occur at rest, make routine activities difficult, and be unresponsive to pain pills.
How is a Rotator Cuff Tear Diagnosed?
Your orthopedist will obtain a history from you to determine if an injury could be responsible for your shoulder symptoms. The doctor will then perform a physical examination to check for shoulder strength and range of motion. They may order imaging tests such as an X-ray, ultrasound, or MRI to make a definitive diagnosis. An MRI can show the size and location of a rotator cuff tear and give your doctor an idea about how long ago the tear occurred.
Treatment for Rotator Cuff Tear
If you have symptoms of shoulder pain, weakness, and limited range of motion, it’s important to seek timely medical care. If you keep using your shoulder despite increasing symptoms, a rotator cuff tear can become larger over time and cause further damage. Appropriate treatment for a rotator cuff tear can relieve your symptoms and help you return to normal life more quickly.
Your doctor will recommend rotator cuff tear treatment keeping in mind your age, lifestyle, and general health. Roughly 80% of patients obtain relief in symptoms with non-surgical treatments, which usually consist of:
- Rest or activity modification (for example, limiting overhead activities to allow time for healing)
- Pain medications (non-steroidal anti-inflammatory drugs like naproxen or ibuprofen to reduce pain and swelling)
- Physical therapy exercises (to help restore range of motion and build strength and flexibility)
- Steroid injections with local anesthetic (to relieve pain and inflammation)
In a small number of patients, a rotator cuff tear requires surgical treatment. This is typically recommended when symptoms have lasted more than 3-6 months, the imaging shows a full thickness tear in a rotator cuff tendon, and there is a significant weakness that has not improved with conservative measures. Surgery may also be necessary after a traumatic injury. A surgeon can repair a rotator cuff tear by reattaching the tendon to the upper arm bone. This can be done in various ways, and the surgeon will discuss options keeping in mind the patient’s health status.