Rotator Cuff Tear
What is a Rotator Cuff Tear?
The rotator cuff is a grouping of tendons and muscles that “cuff” the shoulder joint, helping to keep the bone at the very top of your arm in the shoulder’s socket, which helps the arm raise and rotate. A rotator cuff tear refers to one or more of the rotator cuff tendons being torn, either partially (partial tear) or completely (full-thickness tear).
Rotator cuff tears are very common. According to the Department of Orthopedic Surgery at the University of California, up to 30 percent of the people over the age of 60 have at least a partial rotator cuff tear.
Researchers performed ultrasounds on 664 participants in a study to check the prevalence of rotator cuff tears in the general population. The results, which were published in the Journal of Orthopedics in 2013, showed that of the 147 subjects who were found to have full rotator cuff tears, 65.3 percent of them had no symptoms.
Rotator cuff tear symptoms can range in severity depending on how the injury occurred. A rotator cuff tear caused suddenly due to a fall or accident generally causes intense pain, which may accompany a snapping sensation and sudden weakness. Symptoms of tears that develop gradually over time from excessive use tend to start off mild and worsen as time goes on.
Common rotator cuff tear symptoms include:
- Pain when at rest and at night
- Pain when lifting and lowering the arm
- Pain with certain movements
- Arm and shoulder weakness on lifting or rotation of the arm
- A cracking sensation (crepitus) when moving the shoulder
Rotator cuff symptoms can make it difficult for you to perform simple daily tasks, especially those that require lifting your arms, such as reaching for items on a shelf or brushing your hair. Symptoms may interfere with sleep as they become more severe.
Rotator cuff tears can happen suddenly as a result of acute trauma or gradually because of degenerative changes.
Common causes of acute tears include:
- Falling on your outstretched arm
- A car or sports accident
- Rapid twisting motions of the shoulder
- Lifting something heavy with your arm fully extended
Degenerative tears are caused by a gradual wearing down of the tendon. Degeneration tears can happen due to the following:
- Overuse from repetitive shoulder motions
- Bone spurs
- Poor blood supply
The risk of suffering a rotator cuff tear increases as we age because of the degenerative changes that occur from normal wear and tear over the years, especially past the age of 40.
Other risk factors for rotator cuff tears include:
- Engaging in activities involving repetitive overhead arm motions, such as throwing
- Occupations and activities involving heavy lifting or excessive stress on the shoulder
- Weak shoulder muscles from inactivity or injury
- Shoulder abnormalities or conditions, such as tendinitis or bursitis
To diagnose a rotator cuff tear, your doctor will take your medical history, including what your symptoms are, how long you’ve had them, and whether or not you’ve had an accident that may have caused an injury. The doctor will also perform a physical exam which may include pressing on different areas of your shoulder and manipulating your arm into different positions to test your range of motion and look for weakness.
Imaging tests will likely be ordered and may include:
Even though a rotator cuff tear can’t be seen on an X-ray, this is often the first imaging test used to check for possible causes of your symptoms, such as fractures or bone spurs.
Soundwaves are used to produce real-time images of your body’s structures, including soft tissues.
- Magnetic resonance imaging (MRI).
This is the preferred type of imaging for diagnosing rotator cuff tears because it allows the doctor to visualize the rotator cuff tendon and its size in great detail. It is also helpful in determining whether the tear happened recently or some time ago. MRI images are created using a magnetic field and radio waves without the use of radiation.
Arthrography uses a special dye injected into the shoulder to highlight damage, including rotator cuff tears. This type of test is often used when a person is unable to have an MRI due to a pacemaker.
The goal of rotator cuff treatment is to relieve pain and restore function. There are several options available for treating a torn rotator cuff and doctors will usually recommend the least invasive options first.
Rotator cuff treatment may include one or a combination of the following:
Resting your shoulder and limiting activities that involve reaching overhead or that cause pain is often the first recommended treatment. A sling may be used to immobilize the shoulder. Continued use of the shoulder can worsen a tear.
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen and ibuprofen help to relieve pain and swelling.
- Physical therapy/exercise.
Special exercises can help strengthen your shoulder and improve your range of motion. Physical therapy can also improve pain and help prevent further injury.
- Corticosteroid injections.
These injections contain a combination of cortisone and a numbing agent that relieve inflammation and offer quick pain relief.
Arthroscopic rotator cuff repair is performed using an arthroscope, which consists of a thin tube with a fiber optic camera on the end. This instrument is inserted into the shoulder through a tiny incision. A video monitor is used to view and repair the damage using small instruments passed through another small incision. Recovery time is considerably less than with traditional open surgery.
Surgical treatment may be recommended if your rotator cuff tear symptoms fail to improve with less invasive options or have lasted for several months.