The rotator cuff is a group of muscles and tendons that keep the ball (head) of your upper-arm bone (humerus) in the shoulder socket, while also allowing you to lift, rotate, and move your arm.
Because of the movement and stress of these muscles and tendons, the rotator cuff is prone to tearing – rotator cuff tear.
A rotator cuff tear is a common sports injury, but it can also occur in occupations like painters, carpenters, and window cleaners. An injury or tear usually happens over time from normal wear and tear, or in the case of sports like baseball or tennis, with repeated arm motion. However, a rotator cuff tear can also happen suddenly when falling onto an arm or when lifting something heavy. Furthermore, the risk of a rotator cuff injury also increases with age.
What Is a Rotator Cuff Tear?
There are two types of rotator cuff tears – a partial tear and a full-thickness tear.
- Partial tear. This type of tear is sometimes called an incomplete tear. In many cases, a partial tear begins with fraying, which can become progressively worse until the tissue completely tears.
- Full-thickness tear. This type of tear may also be called a complete tear. In the case of a full-thickness tear, the damage goes all the way through the tissue, creating a hole. Sometimes, a tendon may tear completely away from the bone.
A torn rotator cuff weakens the shoulder and can make many daily activities, like combing the hair or dressing, painful and difficult.
What Causes a Rotator Cuff Tear?
Rotator cuff tears can result from progressive wear and tear, and can also be the result of a sudden, substantial injury to the shoulder.
The following is a list of factors that may increase the risk of having a rotator cuff injury:
- Age. The risk of a rotator cuff injury increases as we grow older. A lack of blood supply to the area, due to changes as we age, can reduce the body’s natural ability to repair itself. If the area is already slightly injured and the blood supply is diminished, a tear is likely. Most rotator cuff tears are the result of a combination of repetitive and degenerative causes. Rotator cuff tears are most common in people over the age of 40.
- Bone Spurs. The development of bone spurs in the bones around the shoulder may irritate or damage the tendon and cause a rotator cuff tear.
- Certain sports. A greater risk of rotator cuff injury occurs in athletes who regularly use repetitive arm motions, such as baseball pitchers, archers, and tennis players. The wearing of the tendons from the repeated motion can cause a rotator cuff tear.
- Construction jobs. Occupations requiring repetitive overhead arm motions, such as carpentry and house painting, can damage the rotator cuff over time.
- Family history. Rotator cuff injuries may have a genetic component since they tend to occur more frequently in certain families.
What are the Symptoms of a Rotator Cuff Tear?
Symptoms of a torn rotator cuff typically result from inflammation in the muscles and tendons that cause swelling. The combination of inflammation and swelling, within the small area of the shoulder joint, prevent a normal range of motion resulting in pain when the shoulder joint moves.
Rotator cuff tears that happen suddenly, such as from a fall, usually create sudden, intense pain. There may be a feeling of a ‘snap’ in the shoulder, and an immediate weakness in the upper arm. Likewise, tears that develop slowly due to overuse also cause pain and arm weakness.
Initially, over-the-counter medication, such as aspirin or ibuprofen, may relieve the pain. However, over time, the pain may become more noticeable while at rest, and the medications no longer help alleviate the pain.
The following are the most common symptoms of a rotator cuff tear. However, the symptoms differ in every patient. Symptoms can include:
- A weakness in the shoulder.
- A weakness when lifting or rotating the arm.
- The inability to lift things as normal.
- A limited range-of-motion of the arm.
- Pain that feels like a dull ache deep in the shoulder.
- Pain when lifting and lowering the arm, or with specific arm movements.
- Pain at rest and at night, especially when lying on the affected shoulder.
- A crackling sensation or sound (crepitus) with certain movements of the shoulder or arm.
It is important to know that some rotator cuff tears are not painful. These tears, however, may still result in arm weakness and other symptoms.
How is a Rotator Cuff Tear Diagnosed?
The diagnosis of a torn rotator cuff begins with a medical history and physical examination of the shoulder. The doctor will ask about previous activities and any acute injuries, as well as previous symptoms that may suggest a long-term problem.
During the physical examination, the doctor will check the range of motion in the shoulder and for muscle strength, as well as any movements that cause pain. The doctor will also check for any other shoulder joint problems. The doctor may also examine the neck to make sure the pain is not the result of a “pinched nerve,” and to rule out other conditions, such as arthritis.
The following tests can help determine the cause of the pain:
- Magnetic resonance imaging (MRI). Technology that uses a combination of large magnets, radio frequencies, and a computer to produce detailed images of organs and structures within the body. The images display all shoulder structures in detail.
- X-rays. Although the soft tissue of a rotator cuff tear won’t show up on an X-ray, this test can reveal whether there are bone spurs or other potential causes of the pain, such as arthritis. X-rays can also show if the top of the arm bone (humeral head) is pushing into the rotator cuff space.
- Ultrasound. As a diagnostic test that produces images of the soft tissue, an ultrasound can help assess the movement of the structures that make up the shoulder.
How is a Rotator Cuff Tear Treated?
It’s important to see a pain management expert when experiencing chronic shoulder and arm pain because early treatment can prevent symptoms from getting worse. The treatment goals are to reduce pain and restore function. However, the best treatment options are not the same for every patient.
In planning treatment, a doctor takes into consideration the patient’s age, activity level, general health, and the type of tear. Sometimes, rest, ice, and physical therapy are all that’s required to allow recovery from a rotator cuff injury. However, if the damage is more severe, or involves a complete tear of the muscle or tendon, surgery may be the best treatment option. Fortunately, 80% of rotator cuff tear patients experience pain relief and improved shoulder function with nonsurgical treatment.
Non-surgical treatments for rotator cuff tears include:
- Rest. Rest and limit activities that require reaching, especially overhead. Sometimes, a sling can be helpful by protecting the shoulder and immobilizing the arm to allow healing.
- Physical therapy. Specific exercises help increase shoulder muscle strength. In most cases, physical therapy will also involve home exercises.
- Activity modification. A physical therapist will offer suggestions on how to use the shoulder in safer, more comfortable ways during daily activities to help prevent further injuries.
- Medications. Over-the-counter medications, like acetaminophen and anti-inflammatory drugs, help reduce the pain and swelling.
- Steroid injection. If rest, medications, and physical therapy do not relieve the pain, injections of a local anesthetic and cortisone can help control pain. Caution must be exercised, as this treatment can weaken the tendon.
- Platelet Rich Plasma (PRP). PRP is a type of injection therapy that may help promote healing of the injured tendons; however, PRP therapy does not help (and may even briefly worsen) a patient’s comfort.
- Stem Cell Therapy. The use of stem cells to treat rotator cuff tears can help alleviate shoulder pain and restore joint damage.
- Ultrasound therapy. One study indicates that Low-Intensity Pulsed Ultrasound may aid in the tendon-bone healing process.
Surgery may be an option for a torn rotator cuff if the pain does not improve with nonsurgical methods. A complete tear may require stitching together the torn area or reattaching the tendon to the bone. In some cases, it may be necessary to take out small pieces of tendon or bone that are stuck in the shoulder joint, or remove small areas of bone or tissue to give the tendons more room to move.
Continued pain is the primary reason for surgery, especially if the patient is very active or is involved in work that requires using the arms above the head. Other signs that surgery may be a good option include:
- Symptoms lasting for 6 to 12 months.
- The tear is large (greater than 3 cm) and the surrounding tendon tissue quality is good.
- There is significant weakness and loss of function in the shoulder.
- The tear is the result of a recent, acute injury.
What if a Rotator Cuff Tear is Not Treated?
Without proper treatment, a rotator cuff injury can lead to permanent stiffness or weakness, which may result in continuing degeneration of the shoulder joint.
Although resting the shoulder is necessary for recovery, keeping the shoulder immobilized for an extended length of time can cause the connective tissue enclosing the shoulder joint to become thickened and tight – a condition known as frozen shoulder.
Like all injuries that cause chronic pain, it is important to seek medical attention from a certified pain management specialist, especially for long-lasting shoulder pain of six months or more that continues to worsen and does not respond to home treatments.
Novus Spine & Pain Center
Novus Spine & Pain Center is in Lakeland, Florida, and specializes in treating the pain from a rotator cuff tear. By using a comprehensive approach and cutting-edge therapies, we work together with patients to restore function and regain an active lifestyle, while minimizing the need for opiates.
Rotator Cuff Tear Resources
What is a Rotator Cuff Tear? (WebMD)
What is My Rotator Cuff? (WebMD)
Rotator Cuff Injuries (Mayo Clinic)
Rotator Cuff Injuries Symptoms and Causes (Mayo Clinic)
Rotator Cuff Injury (Johns Hopkins)
Rotator Cuff Tears (American Academy of Orthopaedic Surgeons)
Rotator Cuff Tear (Wikipedia)
Rotator Cuff Tear (Sports Injury Clinic)
Rotator Cuff Injections (Sports Health)
Stem cell therapy in the management of shoulder rotator cuff disorders (PubMed)
The effects of low-intensity pulsed ultrasound on tendon-bone healing (PubMed)