Overview

A rotator cuff tear is a common cause of shoulder pain and disability among adults. A torn rotator cuff will weaken your shoulder and cause pain. This means that many daily activities, like combing your hair or getting dressed, may become painful and difficult to do.

Anatomy

The shoulder is a ball-and-socket joint: The ball, or head, of your upper arm bone fits into a shallow socket in your shoulder blade.

The rotator cuff is a network of four muscles that come together as tendons to form a covering around the head of the humerus. The rotator cuff attaches the humerus to the shoulder blade and helps to lift and rotate your arm.

Description

When one or more of the rotator cuff tendons is torn, the tendon no longer fully attaches to the head of the humerus. Most tears occur in the supraspinatus muscle and tendon, but other parts of the rotator cuff may also be involved.

There are different types of tears.

  • Partial Tear. This type of tear damages the soft tissue, but does not completely sever it.
  • Full-Thickness Tear. This type of tear is also called a complete tear. It splits the soft tissue into two pieces. In many cases, tendons tear off where they attach to the head of the humerus. With a full-thickness tear, there is basically a hole in the tendon.

Cause

There are two main causes of rotator cuff tears: injury and degeneration.

Acute Tear

If you fall down on your outstretched arm or lift something too heavy with a jerking motion, you can tear your rotator cuff.

Degenerative Tear

Most tears are the result of a wearing down of the tendon that occurs slowly over time. This degeneration naturally occurs as we age.

Several factors contribute to degenerative, or chronic, rotator cuff tears.

  • Repetitive stress. Repeating the same shoulder motions again and again can stress your rotator cuff muscles and tendons.
  • Lack of blood supply. As we get older, the blood supply in our rotator cuff tendons lessens. Without a good blood supply, the body's natural ability to repair tendon damage is impaired. This can ultimately lead to a tendon tear.
  • Bone spurs. As we age, bone spurs (bone overgrowth) often develop on the underside of the acromion bone. When we lift our arms, the spurs rub on the rotator cuff tendon. This condition is called shoulder impingement, and over time will weaken the tendon and make it more likely to tear.

Symptoms

The most common symptoms of a rotator cuff tear include:

  • Pain at rest and at night
  • Pain when lifting and lowering your arm or with specific movements
  • Weakness when lifting or rotating your arm
  • Crepitus or crackling sensation when moving your shoulder in certain positions

Tears that happen suddenly, such as from a fall, usually cause intense pain. There may be a snapping sensation and immediate weakness in your upper arm.

A rotator cuff injury can make it painful to lift your arm out to the side.

Tears that develop slowly due to overuse also cause pain and arm weakness. You may have pain in the shoulder when you lift your arm to the side, or pain that moves down your arm. Over-the-counter medication, such as naproxen or ibuprofen, may relieve the pain at first.

Over time, the pain may become more noticeable at rest, and no longer goes away with medications. You may have pain when you lie on the painful side at night. The pain and weakness in the shoulder may make routine activities such as combing your hair or reaching behind your back more difficult.

Doctor Examination

Medical History and Physical Examination

After discussing your symptoms and medical history, Dr. Wilson will examine your shoulder and will check to see whether it is tender in any area. To measure the range of motion of your shoulder, he will have you move your arm in several different directions and will also test your arm strength.

Imaging Tests

Other tests which may help to confirm your diagnosis include:

  • X-rays. The first imaging tests performed are usually x-rays. Because x-rays do not show the soft tissues of your shoulder like the rotator cuff, plain x-rays of a shoulder with rotator cuff pain are usually normal or may show a small bone spur.
  • Magnetic resonance imaging (MRI). MRI can better show soft tissues like the rotator cuff tendons. They can show the rotator cuff tear, as well as where the tear is located within the tendon and the size of the tear.  Dr. Wilson’s office has an MRI machine on site which adds to your convenience.

Treatment

If you have a rotator cuff tear and you keep using it despite increasing pain, you may cause further damage. A rotator cuff tear will get larger over time.

The goal of any treatment is to reduce pain and restore function. There are several treatment options for a rotator cuff tear, and the best option is different for every person. In planning your treatment, Dr. Wilson will consider your age, activity level, general health, and the type of tear you have.

Many people can get better without surgery and for this reason Dr. Wilson may first recommend nonsurgical management.

Nonsurgical Treatment

In about 50% of patients, nonsurgical treatment relieves pain and improves function in the shoulder.

Nonsurgical treatment options may include:

  • Activity modification. Avoid activities that cause shoulder pain.
  • Non-steroidal anti-inflammatory medication. Drugs like ibuprofen and naproxen reduce pain and swelling.
  • Strengthening exercises and physical therapy. Specific exercises will restore movement and strengthen your shoulder. Your exercise program will include stretches to improve flexibility and range of motion. Strengthening the muscles that support your shoulder can relieve pain and prevent further injury.
  • Steroid injection. An injection of a local anesthetic and cortisone may be helpful. Cortisone is a very effective anti-inflammatory medicine.

Surgical Treatment

Dr. Wilson may recommend surgery if your pain does not improve with nonsurgical methods. Continued pain and dysfunction are the main indications for surgery. If you are very active and use your arms for overhead work or sports, surgery may be recommended sooner.

Surgery to repair a torn rotator cuff involves re-attaching the tendon to the head of the humerus using sutures and bone anchors. 

All-Arthroscopic Repair

Advancements in surgical techniques for rotator cuff repair have made minimally invasive surgery a reality.  Dr. Wilson uses the most minimally invasive techniques to arthroscopically repair the torn tendons.  This allows the least amount of post-operative pain, better motion and quicker recovery.

During arthroscopy, Dr. Wilson inserts a small camera, called an arthroscope, into your shoulder joint. The camera displays pictures on a television screen, and he uses these images to guide small surgical instruments, about the size of a pencil.

Since Dr. Wilson can look inside your shoulder with a camera, he can identify and treat all additional problems at the same time including bursitis, biceps tendon tears, bone spurs and torn ligaments.

Because the arthroscope and surgical instruments are thin, Dr. Wilson can use very small incisions, rather than the larger incision needed for standard, open surgery.

All-arthroscopic repair is an outpatient procedure and is the least invasive method to repair a torn rotator cuff.

Rehabilitation

Rehabilitation plays a vital role in getting you back to your daily activities. A physical therapy program will help you regain shoulder strength and motion after surgery.

Immobilization

After surgery, therapy progresses in stages. At first, the repair needs to be protected while the tendon heals. To keep your arm from moving, you will most likely use a sling and avoid using your arm (except for therapy) for the first 6 weeks.

Passive Exercise

Even though your tear has been repaired, the muscles around your arm remain weak. Once Dr. Wilson decides it is safe for you to move your arm and shoulder, a therapist will help you with passive exercises to improve range of motion in your shoulder. With passive exercise, your therapist supports your arm and moves it in different positions. In most cases, passive exercise is begun within the first week after surgery

Active Exercise

After 4 to 6 weeks, you will progress to doing active exercises without the help of your therapist. Moving your muscles on your own will gradually increase your strength and improve your arm control. At 8 to 12 weeks, your therapist will start you on a strengthening exercise program.

Expect a complete recovery to take several months. Most patients have a functional range of motion and adequate strength by 4 to 6 months after surgery. Although it is a slow process, your commitment to rehabilitation is key to a successful outcome.