Rotator Cuff Tear

Types of rotator cuff tears

• Partial tear — occurs when the tendon that protects the top of the shoulder is damaged.
• Complete tear — occurs when the tear goes completely through the tendon or pulls the tendon from the bone.

Causes of rotator cuff tears

A rotator cuff tear can occur as a result of an acute injury or chronic wear and tear.

Causes of acute rotator cuff tears

An acute rotator cuff tear can occur if you fall directly on your outstretched arm. An acute tear typically occurs with other injuries, such as a dislocated shoulder or a fractured collarbone.

Causes of degenerative rotator cuff tears

A degenerative rotator cuff tear occurs slowly as the tendon in the shoulder wears down. This could occur due to the following factors:

• Stress on the shoulder — sports such as swimming, baseball and tennis or occupations such as painting can add stress to the shoulder.
• Lack of blood supply — as you age, less blood gets to the shoulder tendons. Without proper blood to repair damage, the tendons can tear.
• Bone spur — bone spurs can develop as you age that rub on the rotator cuff tendon, which can weaken the tendon and make it more prone to tears.

Risk factors for rotator cuff tears

• Overuse — people who participate in activities, such as swimming, softball and volleyball, that require overhead shoulder movement are more likely to be at risk for a rotator cuff tear.
• Age — rotator cuff injuries more frequently occur in people over the age of 40 and occur at a greater rate as you age.
• Shoulder arthritis — arthritis can cause shoulder instability, muscle weaknesses and bony cysts.

Symptoms of rotator cuff tears

Contact your doctor right away if you have any of the following symptoms of a rotator cuff tear:

• Trouble raising your arm
• Unable to lift objects that are normally easy to lift
• Clicking, cracking or popping sensation in the shoulder when you move your arm
• Pain that is felt when you move your arm or lie on it
• Weakness when lifting or moving the arm

Diagnosis of rotator cuff tears

A rotator cuff tear is diagnosed in a full physical exam with your doctor.

Your doctor will take your full medical history and determine how the injury occurred and what activities make your symptoms worse. The provider will also move your shoulder to determine range of motion and what positions make the symptoms feel the worst.

Your doctor may order an MRI to confirm your diagnosis, they can show where the tear is located or give the doctor an idea if the tear is new or old.

Treatment of rotator cuff tears

It is important to seek treatment right away if you suspect you have a rotator cuff tear. If you leave the injury untreated, the tear could get larger and you could develop arthritis or a frozen shoulder.

Many doctors recommend treating rotator cuff tears with physical therapy and other nonsurgical treatments before surgery. Approximately 80% of patients can find relief with nonsurgical treatments.

Nonsurgical treatments for a rotator cuff repair include:

• Rest — limit arm movements above the head
• Sling — keeps arm movements to a minimum
• Activity modification — avoid any activities that may cause shoulder pain
• Medications — nonsteroidal anti-inflammatory medications like ibuprofen can reduce pain and swelling
• Physical therapy and rehabilitation — your physical therapist will prescribe exercises and stretches to restore movement in the arm and strengthen the shoulder
• Steroid injection — a cortisone shot can help relieve the pain and reduce swelling, but it is not effective for all patients

If the tear continues to increase in size, you have significant weakness in your shoulder and symptoms continue after being treated with nonsurgical treatments for six to 12 months, you may need to have surgery.

• Tendon transfer surgery
• Arthroscopy (shoulder replacement surgery) — minimally-invasive procedure where camera and surgical instruments are guided through a small incision in your shoulder to repair the torn tissue.
• Open repair — an incision is made in the shoulder and the shoulder muscle is detached to see the torn tendon and repair the injury; typically done on injuries that are large and complex.
• Mini open repair — a mini open repair uses arthroscopic techniques to identify and treat damage to structures in the shoulder joint without having to detach the deltoid muscle.

Each of these rotator cuff surgeries has similar results in terms of pain relief, improved strength and function and patient satisfaction.

Recovery from rotator cuff tears

Most patients will be able to return to their normal activity level after a rotator cuff repair. You should work closely with your surgeon and orthopedic surgeon to develop a rehabilitation plan that slowly ramps up activity for the affected shoulder.

If you have poor tendon quality, large tears, are older than 65 or you do not follow your doctor’s instructions, you are less likely to have positive results after surgery.