What is rotator cuff tear?

Rotator cuff tear is a type of injury to your rotator cuff that causes shoulder pain and prevents you from using your arm. It is a group of muscles and tendons surrounding your shoulder. They help you lift your arms and move them away from your body. Your rotator cuff keeps the ball of your upper arm bone (humerus) in the socket of the shoulder bone.

Your shoulder is a true ball-and-socket joint of your body's skeletal system. Imagine a golf ball resting on top of a golf tee. A rotator cuff tear occurs when the tendons separate from your arm bone. It happens for any number of reasons, whether it's overuse or injury.

What are the classifications of rotator cuff tears?

There are various subtypes of torn rotator cuffs, including

Partial: Your tendon is only partly torn and still attached to your bone in a partial tear.
Full-thickness or complete tear: Your tendon is completely separated from your bone. You have a hole or tear in your tendon.

How common are rotator cuff tears?

More than 2 million people suffer some kind of rotator cuff problem in America each year. Rotator cuff tears occur in every age group but are much more common in adults. In fact, it is so common that there are people who have rotator cuff tears and they don't even know they do because they don't feel any symptoms.

What are the symptoms of a rotator cuff tear?

The symptoms of a rotator cuff tear include:

Pain, aching, and weakness with lifting, lowering, or turning your arm.
Grating or crunching feeling when you move your arm in certain positions
Night pain
Weakness in the shoulder and unable to lift things.

You may experience a dull ache deep within your shoulder or feel as if being stabbed by a knife. You will experience sudden severe shoulder pain and weakness in your arm resulting from sharp pain due to accidents or trauma. With degenerative tears, you will likely experience minimal shoulder pain that improves with OTC pain relievers, but over time, the pain gradually worsens and pain relievers no longer help. Not everyone suffers from pain, but almost every person has some level of weakness in the arms and shoulders.

What causes rotator cuff tears?

A fall can break your collarbone or even dislocate your shoulder, which tears your rotator cuff.

More often, a rotator cuff tear occurs over time as your tendon breaks down from wear and tear associated with aging and use (degenerative tear). People are most commonly at risk after age 40.

Causes of degenerative tears include:

Bone spurs: You are going to develop bony growths on top of your shoulder bone. As you raise your arm, the bony growths rub against your tendon, causing an impingement on your shoulder. Impingement will cause friction to develop between your bone and tendon. You will end up with a partial or complete tear.
Poor blood flow: The flow of blood to your rotator cuff decreases with age. Your muscles and tendons need proper blood flow to self-repair. If your tendons do not receive blood, they can tear.
Overuse: Repeated movements at the shoulder from athletics or work will cause an overuse injury that directly stresses your muscles and tendons and may cause a tear.

What puts you at risk for rotator cuff tears?

ANYONE can sustain a rotator cuff tear. The following conditions increase your chances of developing one:

Family history of shoulder disorders or rotator cuff tears.
Poor posture.
Smoking.
Age 40 years or older.

Degenerative tears tend to be more common in people performing repetitive activities at the shoulder, such as:

Carpenters
Auto mechanics
Artists who paint
Recreational and professional athletes who play baseball, softball, and tennis, or who are part of a rowing crew.

A rotator cuff tear worsens with time if not treated. A complete tear can make it nearly impossible to move your arm. If you don't have surgery, you may have chronic shoulder pain and be very disabled in your use of your injured arm.

How Is a Rotator Cuff Tear diagnosed?

Your provider will perform a physical examination to look for tenderness in the shoulder, test for range of motion, and check strength in the arm.

To confirm a diagnosis, you may get:

An X-ray to exclude arthritis or bone spurs.
An MRI or ultrasound to exclude tendon tears.

What is the treatment for a rotator cuff tear?

Rotator cuff tear treatment can be either nonsurgical and surgical.

Nonsurgical:

Rotator cuff tears cannot heal by themselves and must have surgery; however, many people can improve functionally and decrease pain with nonsurgical care by conditioning their shoulder muscles. It does not necessarily mean that someone has to go in for surgery because many people have rotator cuff tears and never discover that. Eight out of 10 people with partial tears recover with nonsurgical treatments. It may take up to a year for the condition to improve.

Nonsurgical treatments include:

Support your arm in an arm sling and rest-give your shoulder a chance to get better. You may need to change your activities and put work or sports on hold for a period.

NSAIDs, such as ibuprofen, are prescribed to help control the pain and swelling

Physical therapy helps you learn exercises for strengthening and stretching

Steroid injections to ease the pain and swelling

Surgical intervention:

In case of a complete tear, your doctor may refer you to have surgery. In case of a complete or partial tear, if nonsurgical treatments are not helpful, then surgery also may be recommended. You may have surgery if your work activities or other sporting interests affect your shoulder.

Most rotator cuff operations are done arthroscopically through minor cuts. The surgeon rarely has to use an open technique when he or she deems it necessary. The surgery is performed on an outpatient basis. You will go home the same day; however, your recovery after this surgery is significant and can take up to a year or more in overall impact.

Your doctor does the following during surgery:

Insertion of an arthroscope - it is a small camera that is inserted through a small cut in your shoulder.

It refers to images from the arthroscope in carrying out the procedure.

Pushes small instruments through small incisions in your shoulder to remove spurs and reattach your tendon back to your upper arm bone.

If it's a partial tear, a healthcare provider might just need to remove the fraying pieces of a tendon that is partially torn. This process, called debridement, keeps your shoulder ball and socket from catching on your tendon and tearing it more.

Some tears are too large and/or are too old to be repaired. In such instances, you may need a reverse shoulder replacement, or tendon transfer, or merely a debridement of scar tissue with no repair.

How long does it take to recover from a rotator cuff tear?

You would need to use a sling after surgery to immobilize your arm for four to six weeks. Then you can initiate your course of physical therapy. Generally, the patient regains the ability and strength of the shoulder within four to six months following surgery, but optimal recovery can take up to 12 to 18 months.

How do I prevent a symptomatic rotator cuff tear?

Prevention treatment of a symptomatic rotator cuff tear is by keeping the muscles and tendons limber. You might be given some exercises to do at home by your healthcare provider.

What are the outcomes for someone who has a rotator cuff tear?

Most people recover with non-operative treatments. Recovery is a matter of weeks and longer because your body needs time to heal. Most people whose torn rotator cuff was surgically repaired regain their function.

You may well tear the same tendon again. This is especially true for you if your original tear was more than 1 inch large. A re-tear that causes significant pain or loss of motion may require surgery.