Rotator cuff injuries, including rotator cuff tears, are common. In the U.S., 2 million people per year visit their doctors 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 comprised of a ball and socket — the ball, or head, fits into a socket in your shoulder blade. The rotator cuff keeps your arm in your shoulder socket. This 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, meanwhile, is a lubricating sac located in 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 is no longer fully attached to 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 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.”
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.
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 a tear caused by overuse, as well.
- Lower blood supply: As people age, the blood supply in the rotator cuff tendons decreases. Without good blood supply, 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 tear.
What puts you at risk for a rotator cuff tear?
The following risk 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 that are caused by wear-and-tear over time.
- 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 for rotator cuff injuries.
Young people can experience rotator cuff tears from sports or overhead work; however, they are more likely to have a tear caused by a traumatic injury.
Rotator cuff tear symptoms
Common symptoms for a rotator cuff tear include:
- Weakness and/or pain when lifting or lowering your arm.
- Pain while resting and at night, particularly if you’re lying on the affected shoulder.
- Difficulty in lifting things as normal.
- Crepitus, or a grating sensation, when moving the shoulder in certain positions.
What does a rotator cuff tear feel like?
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.
Something to note is that you can 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.
How is a rotator cuff tear diagnosed?
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).
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, which may be indicative of a tear, or any other problems if they exist.
- MRI: An MRI can display the rotator cuff tear along with its location and size, which your doctor can use to determine how long you’ve had it based on the quality of the rotator cuff muscles.
Can a rotator cuff tear heal on its own?
In most cases, a rotator cuff tear will not heal on its own. Instead, without treatment, rotator cuff 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 not moving your shoulder for a prolonged period of time, either — instead of healing the tear, this can lead to frozen shoulder.
However, while tears cannot heal on their own, surgery isn’t necessarily required.
How do you treat a rotator cuff tear?
Nonsurgical rotator cuff tear treatment
Many rotator cuff tears can be treated without surgery. In fact, 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:
Avoid activities that cause shoulder and arm pain.
Ibuprofen and naproxen can help reduce swelling and pain.
Exercises 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,
If the other treatments do not help, then corticosteroid injections can help reduce inflammation and pain.
Rotator cuff tear surgery
If you are experiencing pain at night and difficulty lifting and reaching with the affected arm, despite medication and activity modification, you may need surgery.
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.”
Other 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: You have an acute tear.
The type of surgery used to treat a rotator cuff tear depends on the type of tear and 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 outcomes with high 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.
How do you treat a rotator cuff tear?
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 how long the rotator cuff was torn. It may take anywhere from 4-6 months to a year to fully recover.
Alexander Orthopaedics is here to be your partner in full recovery. Whether you need orthopedic surgery, physical therapy, or both, we pride ourselves on creating holistic, individualized treatment plans for our patients. Our team of expert physicians and physical therapists will determine a shoulder surgery and treatment plan that works best for you.