Rotator Cuff Tear

A rotator cuff tear is a very common cause of pain and disability among adults. In 2013, almost 2 million people in the United States went to their doctors because of a rotator cuff problem. A torn rotator cuff can weaken your shoulder and make daily activities painful and hard to perform.

Anatomy:

rotator cuff muscles

Your shoulder is made up of three bones: your upper arm bone (humerus), your shoulder blade (scapula), and your collarbone (clavicle). 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.

Your arm is kept in your shoulder socket by your rotator cuff and supporting ligaments. The rotator cuff is a group 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.

  • Supraspinatus – raises the arm to the outside
  • Infraspinatus –externally rotates the arm
  • Teres Minor – externally rotates the arm
  • Subscapularis – internally rotates the arm

There is a lubricating sac called a bursa between the rotator cuff and the bone on top of your shoulder (acromion). When the rotator cuff tendons are injured or damaged, this bursa can also become inflamed and painful.

Description:

When one or more of the rotator cuff tendons is torn, the tendon no longer fully attaches to the head of the humerus. The supraspinatus tendon is the most commonly torn tendon. In many cases, torn tendons begin by fraying. As the damage progresses over time, the tendon can completely tear. There are different types of tears:

  • Partial tear: This type of tear is also called an incomplete tear. It damages the tendon, but does not completely sever it.
  • Full-thickness tear: This type of tear is also called a complete tear. It separates all of the tendon from the bone. These full thickness tears can be very small to very large.  

Cause:

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

Injury (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 (Chronic Tear): The vast majority of tears are the result of a wearing down of the tendon that occurs slowly over time. This degeneration naturally occurs as we age. If you have a degenerative tear in one shoulder, there is a possibility of a rotator cuff tear in the other. Several factors contribute to degenerative (chronic) rotator cuff tears including:

  • Repetitive stress: Repeating the same shoulder motions again and again can stress your rotator cuff muscles and tendons, such as sports or physically demanding jobs. 
  • Age: people over the age of 40 have a higher likelihood of rotator cuff tears than those under the age of 40.

Imaging:

X-rays will be taken at your visit to rule out any arthritis of the shoulder or AC joint. Unfortunately, x-rays do not show the soft tissues of your shoulder like the rotator cuff.

An MRI is necessary to evaluate the soft tissues of the shoulder, like the rotator cuff tendons partial or full-thickness tears. An MRI can also give your doctor a better idea of how "old" or "new" a tear is because it can show the quality of the rotator cuff muscles.  

Treatment:

Nonsurgical Treatment
In many cases, treatment is nonsurgical. These treatments include:

  • Rest and modification of activities to avoid aggravating your symptoms.
  • NSAIDs, such as Ibuprofen and Aleve, to reduce pain and swelling.
  • Physical therapy to help restore normal motion and strength to your shoulder.
  • Steroid injection to reduce inflammation & pain.

Surgical Treatment

rotator cuff muscles

When non-surgical treatment does not relieve pain, or if you have a large tear, your doctor may recommend surgery.

This is usually an arthroscopic surgery, which is minimally invasive, using very small incisions and a camera in the shoulder joint. The goal of surgery is to reattach the torn rotator cuff tendon back to the bone, as well as promote healing. This involves using very strong semi-permanent sutures to repair the tendon and attempt restoring your normal shoulder anatomy. If other issues like biceps tendinitis, a bone spur, or AC joint arthritis are present, these will be addressed at the time of surgery, as well. 

This is an outpatient surgery that allows you to go home the same day. You will be placed in a sling to avoid any shoulder movement, but you will be allowed to shower and exercise your elbow/wrist/fingers. Physical therapy will begin 1-2 weeks after surgery.