Rotator cuff injuries, including rotator cuff tears, are common. In the United States, 2 million people per year visit the doctor due to a rotator cuff problem, including tears. Tearing your rotator cuff can weaken the shoulder and make daily activities difficult.
What is the rotator cuff?
The shoulder joint is composed of a ball and socket — the ball, or head, fits into a socket in your shoulder blade. The rotator cuff keeps your arm securely in your shoulder socket. A group of four muscles comes together to form a covering around the head of the humerus, or upper arm bone.
The rotator cuff attaches the upper arm bone to the shoulder blade, which helps you rotate and lift your arm. It also helps to stabilize the ball of the shoulder within the joint.
The bursa is a lubricating sac located between the rotator cuff and the bone on top of your shoulder. It allows the rotator cuff tendons to glide when you move your arm. So, when the rotator cuff is damaged, the bursa can also become inflamed.
Common rotator cuff injuries include rotator cuff tendonitis, rotator cuff strain, and rotator cuff tears.
What is a rotator cuff tear?
A rotator cuff tear occurs when the tendon partially or fully detaches from the head of the humerus. The torn tendons begin fraying and, as the damage progresses, the tendon can completely tear.
Types of rotator cuff tears
There are two types of rotator cuff tears:
- Partial, or incomplete, tear: The tendon is damaged but not completely severed.
- Full-thickness, or complete, tear: The tendon is separated from the bone, and there is essentially a hole in the tendon.
What are the symptoms of a rotator cuff tear?
Common symptoms for a rotator cuff tear include:
- Weakness and/or pain when lifting or lowering your arm.
- Pain while laying down, particularly when lying on the affected shoulder.
- Difficulty in lifting things as normal.
- Crepitus, or a grating sensation, when moving the shoulder in certain directions.
What does a rotator cuff tear feel like?
If you have shoulder pain, you may ask yourself, “How do I know if I tore my rotator cuff?” This kind of tear is different from other shoulder injuries. What a rotator cuff tear feels like depends on the type of tear.
An acute rotator cuff tear causes intense pain, as well as a snapping sensation and immediate weakness in the upper arm.
Degenerative tears also cause pain and arm weakness, but the symptoms may be mild at first. You may start to experience pain in the front of your shoulder that radiates down the side of your arm. After a period of time, however, the pain will become more noticeable while resting, and it will start to interfere with everyday activities like brushing your hair or reaching your back.
You can also have a rotator cuff tear without experiencing symptoms. The chance of having an asymptomatic rotator cuff tear increases with age, according to research published in The Journal of Shoulder and Elbow Surgery.
What causes a rotator cuff tear?
Rotator cuff tears are either caused by an injury or by degeneration. According to Dr. Vladimir Alexander, Founding Partner of Alexander Orthopaedics:
“If you ignore shoulder impingement or rotator cuff tendonitis for a long time, and you live with the symptoms, it can turn into a rotator cuff tear. Rotator cuff tears can also happen for other reasons, such as trauma.”
Acute tear
Rotator cuff tears can occur from injuries like falling down on an outstretched arm or lifting something too heavy. Acute rotator cuff tears are often accompanied by another type of shoulder injury, like a dislocated shoulder or broken collarbone.
Degenerative tear
Rotator cuff tears are more likely to be caused by the tendon slowly wearing down over time. These degenerative, or chronic, tears often happen in the more dominant arm, due to several contributing factors, including:
- Repetitive movement and stress: Repeated shoulder motion causes stress in the rotator cuff muscles and tendons. Sports like baseball, rowing, weightlifting, and tennis can put you at risk for these overuse tears. Specific occupations and chores can lead to overuse as well.
- Lower blood supply: As people age, the blood supply in the rotator cuff tendons decreases. Without a steady, strong blood supply to the shoulder joint, it becomes more difficult for the body to repair tendon damage, which can lead to a tendon tear.
- Shoulder impingement: Bone overgrowth, or spurs, can rub on the rotator cuff tendon, which weakens the tendon over time, causing it to eventually tear.
Risk Factors
The following factors can put you at a greater risk for a rotator cuff tear:
- Age: People over 40 are at a greater risk for rotator cuff tears, due to shoulder wear-and-tear over time. Young people are more likely to have a tear caused by a traumatic injury.
- Sports: Athletes, such as tennis players and baseball pitchers, are vulnerable to overuse tears.
- Occupation: People who do overhead work in their profession, like painters and carpenters, are at greater risk of a tear.
- Family history: There may be a genetic component to rotator cuff injuries.
How is a rotator cuff tear diagnosed?
Doctor examination
Your doctor will examine your shoulder after reviewing your medical history and discussing your symptoms.
They will see if the area is tender and if there is any deformity. They will also test your range of motion and your arm strength.
One test that a doctor may perform to diagnose a rotator cuff tear is the drop-arm test. In this test, the patient slowly lowers their arm to their waist. If they have a rotator cuff tear, they will be unable to lower the arm as far as the waist. Overall, the key to identifying a rotator cuff tear is pain accompanied by weakness, according to the American Academy of Family Pediatrics (AAFP).
Imaging tests
In addition to a physical examination, your doctor may use imaging tests to confirm their diagnosis, including:
- X-ray: An X-ray cannot show a rotator cuff tear, as it does not display soft tissues, but it will show bone spurs and other skeletal problems, which can be indicative of a tear.
- MRI: Magnetic Resonance Imaging can display the rotator cuff tear, identifying its location and its size. Your doctor can determine how long the tear has been in place based on the quality of the rotator cuff muscles themselves.
What is the treatment for a torn rotator cuff?
As with most orthopedic injuries and conditions, there are many ways to treat these tears — your doctor will develop a treatment plan that addresses your individual needs.
Can a torn rotator cuff heal on its own?
In most cases, a rotator cuff tear will not heal on its own. Instead, the tears can get larger and increase in pain over time, leading to permanent loss of motion or weakness in the shoulder.
It isn’t as easy as resting and reducing movement. Instead of healing the tear, this can lead to frozen shoulder. However, while tears cannot heal on their own, surgery isn’t always necessary.
How do I know if I need surgery?
Based on diagnostic information, your doctor will decide whether to recommend a surgical procedure. Some factors that determine whether or not you should have surgery include:
- Duration of symptoms: Your symptoms have lasted 6 to 12 months.
- Size of tear: Your tear is large (more than 3 cm) and is surrounded by high-quality tissue.
- Loss of function: You are experiencing weakness and loss of function.
- Type of tear: An acute tear is more likely to require surgical intervention.
Nonsurgical rotator cuff tear treatment
Many rotator cuff tears can be treated without surgery. In fact, incomplete rotator cuff tears are treated non-surgically in about 80% of patients. In addition to rest, the following can be used as treatment before resorting to surgery:
Many patients wonder what to do about pain and discomfort, especially to relieve rotator cuff pain at night. There are several ways to ease pain from these tears.
- Activity modification: Avoid activities that cause shoulder and arm pain.
- Medication: Ibuprofen and naproxen can help reduce swelling and pain.
- Exercise and physical therapy: Exercises can help restore strength, flexibility and motion in the shoulder, but they should be selected and performed under the guidance of an experienced physical therapist. Strengthening your shoulder and surrounding areas can help reduce pain and prevent further injury.
- Steroid injection: If the other treatments do not help, then corticosteroid injections can help reduce inflammation and pain.
Rotator cuff tear surgery
If you’ve tried medication, exercise, and activity modification, but are still experiencing pain and difficulty lifting and reaching, your doctor might recommend shoulder surgery on the affected arm.
Dr. Alexander says,
“If you do have a torn rotator cuff, if it’s a full-thickness tear in a functional and active patient, usually they get it repaired arthroscopically. If it’s a partial tear or just an irritation of the rotator cuff, it’s treated like rotator cuff tendonitis or impingement syndrome.”
What type of surgery do I need?
The type of surgery used to treat a rotator cuff tear depends on the type of tear and the overall condition of the patient:
- Arthroscopic surgery: In a shoulder arthroscopy, your doctor will make a small incision in your shoulder and then use an arthroscope to fix the tear. Arthroscopic surgery is ideal because it has a shorter recovery time compared to other forms of surgery. In addition, studies show that arthroscopic rotator cuff repair has long-lasting positive outcomes with high rates of patient satisfaction.
- Open repair: In an open repair, your doctor will use larger instruments on the muscles of the shoulder to fix the tear.
- Mini-Open: A combination of arthroscopic and open methods, your doctor will start with an arthroscope and then finish with larger instruments.
- Shoulder replacement: If the rotator cuff tear is significantly large, you may need a shoulder replacement, which can sometimes be performed in an outpatient setting.
What is the rotator cuff surgery recovery time?
If you have surgery to treat your rotator cuff tear, you will need to wear a sling for 4-6 weeks. The exact recovery time depends on the type of surgery you received, the size of the tear, and the age of the injury. It may take anywhere from 4-6 months to a year to fully recover from the surgery.
Schedule an Appointment
Our team at Alexander Orthopaedic Associates is highly qualified and ready to treat your rotator cuff tear. We’re known as a leading authority in orthopedic care and, with many outpatient services available, we’re a convenient choice for both professional and amateur athletes.
Whether you need physical therapy or orthopedic diagnosis, treatment, or surgery, we pride ourselves on creating holistic, individualized treatment plans for our patients.