Rotator Cuff Tear
Rotator cuff tears are among the most frequent causes of shoulder pain and disability among Americans, affecting more than 2 million people annually.
A torn rotator cuff affects the shoulder and can make many routine activities such as taking a shower, raising the arms overhead, and even brushing one’s hair, difficult and painful.
What Is the Rotator Cuff?
The shoulder joint comprises three bones forming a ball-and-socket: the upper arm bone (humerus), the shoulder blade (scapula), and the collarbone. The head of the upper arm rests in a hollow crevice in the scapula and is held in place by an array of muscles and tendons known as the rotator cuff. The rotator cuff envelops and secures the shoulder joint, allowing for elevation and rotation of the arm.
A lubrication-filled sac known as a bursa cushions the bone and facilitates the smooth gliding of the rotator cuff tendons as the arm moves. If the tendons become injured, the bursa can swell up causing pain and limiting arm mobility.
Causes and Risk Factors of Rotator Cuff Tears
In the majority of rotator cuff tears, the tendon tears away from the bone and is no longer fully attached to the head of the arm bone (humerus).
In the early stages, a tendon may become frayed through an injury, repetitive motion or wear and tear. As tendon damage deteriorates, the tendon may tear completely.
There are several ways the rotator cuff can tear:
- Partial or incomplete tear: the tendon is damaged but not completely severed.
- Full-thickness or complete tear: the tendon is completely separated from the bone.
- Acute tear: can occur if you fall on your arm or try lifting a heavy object by jerking it off the ground; it may happen in conjunction with a broken collarbone or dislocated shoulder.
- Degenerative tear: Wear and tear over time can erode the rotator cuff, especially in one’s dominant arm. People with degenerative tears in one shoulder are likely to experience a rotator cuff tear in the other shoulder even if no symptoms are present.
The causes of rotator cuff tears include:
- Repetitive and stressful motions: many sporting or work-related movements can cause overuse of the rotator cuff, not to mention household chores. Pitching in baseball, weightlifting, and serving in tennis can all erode the rotator cuff tendons.
- A decrease in blood supply: with age, the joints receive less blood flow impairing the body’s natural ability to heal.
- Bone spurs: over time, bone overgrowths can form beneath the acromion bone causing impingement and discomfort when raising the arms and lead to a tendon tear.
Symptoms of a Torn Rotator Cuff
Common symptoms of a torn rotator cuff include:
- Pain when lying down at rest or on the distressed shoulder
- Significant weakness or discomfort when raising or rotating the arm
- Cracking or snapping sensations during specific shoulder movements
A rotator cuff tear arising from a fall normally causes severe pain accompanied by instant weakness in the arm. A tear that evolves gradually from repetitive motions or overuse may come with discomfort while engaging in certain actions or pain radiating down the arm. Some tears do not cause pain; however, patients may still experience fragility in the arm.
According to the American Academy of Orthopaedic Surgeons, nonsurgical treatment alleviates shoulder pain and restores mobility in approximately 80% of patients.
Conservative treatment options include:
- Rest and restricting certain arm movements and other activities that cause pain
- A sling
- Over-the-counter pain medicine such as aspirin or ibuprofen can curtail discomfort and inflammation
- Exercise, stretching, and physical therapy to enhance flexibility and mobility
- Steroid injections such as cortisone
When conservative methods fail to resolve the symptoms of pain and swelling over a considerable amount of time, an orthopaedic surgeon may recommend surgery as a last line of defense. The good news is that there is no urgency to have surgery closer to the time of injury as studies show the effectiveness of surgery to be the same regardless of when the rotator cuff tear occurred.
Surgery typically entails re-attaching the tendon to the upper arm bone. Different types of surgeries can be performed to repair rotator cuff injuries including:
- Arthroscopic tendon repair guided by a small camera to reattach the torn tendon to the bone
- Open tendon repair requiring larger incisions
- Tendon transfer from a nearby tendon if the damaged tendon is unrepairable
- Shoulder replacement for extensive rotator cuff injuries uses artificial components to repair and stabilize the injured shoulder joint
Patients can often obtain full range of motion and strength back in the shoulder after surgery with the help of a guided physical therapy program and rehabilitation program.