Rotator cuff injuries are very common, especially with people over the age of 40. Every year, nearly 2 million people in the United States experience a rotator cuff tear. It is a common cause of shoulder pain and disability among adults because of normal wear and tear. Athletes like baseball players and tennis players are especially vulnerable to overuse tears. Occupations that require overhead work consistently like painters and carpenters are also at greater risk of rotator cuff tears. Simple daily tasks like combing your hair or getting dressed may become painful due to a torn rotator cuff.
In a healthy shoulder, the ball of the humerus is held in the shoulder socket by several muscles and tendons, including the rotator cuff tendons.
Your shoulder is composed of three bones: the humerus, scapula, and clavicle. The shoulder is a ball-and-socket joint; the head of the upper arm or the “ball”, fits into a shallow socket in the shoulder blade. The rotator cuff keeps your arm in your shoulder socket and helps to lift and rotate your arm. Your rotator cuff consists of a group of four muscles that come together to form tendons that cover the head of the humerus, which helps you to rotate and raise your arm. A lubricating sac called a bursa is located between the rotator cuff and the acromion, the bone on top of the shoulder. The bursa allows the rotator cuff tendons to freely glide as your arm moves. When the rotator cuff tendons are injured or damaged, the bursa can also be affected, causing pain and inflammation. This is often called rotator cuff syndrome.
The tendon can completely detach or at least partially from the head of the humerus when your rotator cuff tendon is torn. The tendon most typically torn is the supraspinatus tendon. In many cases, torn tendons begin fraying, and as it continues to be damaged, the tendon completely tears. There are varying types of tears:
- Partial tear – does not completely detach tendon from the bone. The tear partially goes through the thickness of the tendon.
- Full-thickness tear – part of the tendon is detached from the bone. A full-thickness incomplete tear is when a small part of the tendon is detached from the bone. A full-thickness complete tear is when a tendon is completely detached from the bone and a hole in the tendon is visible.
Rotator cuff tears are caused mainly by injury and continual wear and tear or degeneration. An acute tear can occur if you fall down on an outstretched arm or lift something very heavy with a jerking motion. A degenerative tear is caused by wearing down the tendon over time. It is more common in the dominant arm; however, if a degenerative tear is in one shoulder, the likelihood of a rotator cuff tear in the opposite shoulder is common. Two major factors contribute to degenerative rotator cuff tears:
- Repetitive stress – Doing the same shoulder motions over and over again can stress your rotator cuff muscles and tendons. Many athletes who play baseball, tennis, row, or weightlift are at greater risk of overuse tears.
- Lack of blood supply – As we age, blood supply in our rotator cuff tendons lessen, which impairs our body’s natural ability to repair damaged tendons and can ultimately lead to a tendon tear.
Common symptoms of a rotator cuff tear include:
- Pain while resting or at night, especially while lying on the affected shoulder.
- Pain or weakness while lifting, lowering, or rotating your arm.
- Feeling a crackling sensation called crepitus while moving your shoulder.
Traumatic tears that are usually caused by a sudden fall can cause severe pain. You may feel a snapping sensation and immediate weakness in your upper arm.
Gradual rotator cuff tears may be mild in pain at first and more noticeable when lifting your arm over your head. Over-the-counter medications like aspirin or ibuprofen may relieve the pain. Over time, however, the pain may not be relieved by these medications and your pain may worsen even while at rest. You may have more pain at night while resting on that side.
Not all rotator cuff tears are painful. These tears may result in arm weakness and other symptoms. Each individual responds differently to tendon damage.
Dr. Stowell will discuss your symptoms and medical history. He will examine your shoulder for tenderness and any deformity. He will move your arm in several different directions to measure your shoulder’s range of motion. He will also test your arm strength and check for any additional problems with your shoulder joint. Dr. Stowell may also check your neck to make sure that your pain is not coming from a pinched nerve and to rule out other conditions like arthritis.
To confirm your diagnosis, Dr. Stowell may order imaging tests such as X-rays to rule out other possibilities like arthritis or an MRI to better examine the extent of your rotator cuff tear. An MRI can show Dr. Stowell how old or new a tear might be by showing the quality of your rotator cuff muscles.
If left untreated, your rotator cuff tear can get larger and cause further damage. Chronic shoulder and arm pain are good reasons to see your doctor and will help restore your peak potential more quickly.
Nonsurgical treatments relieve pain and improve function in about 85% of patients and includes the following:
- Rest – Rest and limiting overhead activities.
- Activity modification – Avoid activities that cause shoulder pain.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) – Ibuprofen, aspirin, and naproxen can reduce pain and swelling.
- Strengthening exercises – Specific strengthening exercises can help the muscles that support your shoulder, which will relieve pain and prevent further injury to your shoulder.
- Physical Therapy – An exercise program will restore movement and strengthen your shoulder’s flexibility and range of motion.
- Steroid injection – If rest, activity modification, medications, strengthening exercises, and physical therapy do not relieve your pain, an injection of cortisone coupled with a local anesthetic may be helpful. Cortisone is a very effective anti-inflammatory medicine for most patients. The pain-relieving effects of cortisone vary by patient; it may last weeks, months, years and in some cases, the rest of your life. About two-thirds of patients receive about three months of pain relief from cortisone injections.
Surgical treatment may be recommended if your pain does not improve with nonsurgical methods and you show signs of the following:
- Prolong symptoms of pain lasting over 6 months.
- Large tear that is more than 3cm and the quality of your surrounding tissue is good.
- You have significant weakness or loss of function in your shoulder
- Your tear was caused by a traumatic injury.
Repairing your torn rotator cuff with surgery involves re-attaching the tendon to the head of the humerus. Dr. Stowell will discuss with you the procedure to repair your rotator cuff tear to meet your individual health needs.