Rotator Cuff Tear
Rotator cuff tear at a glance
- A tear of the rotator cuff (a set of muscles and tendons that connects the shoulder socket to the ball) occurs when the tendon(s) are torn through an injury or normal activity, such as raising objects above the head.
- Rotator cuff tears commonly occur because the tendons have been weakened through the aging process, degeneration or trauma.
- Symptoms may include intense pain and a popping sensation at the time of injury, followed by weakness and difficulty moving the shoulder and arm, and pain in the shoulder during sleep.
- Initial treatment should include rest, alternating ice and heat, pain medication and physical therapy.
- When initial treatments fail, rotator cuff tears may require shoulder surgery to repair the tendons and restore functionality.
- Injection based therapies such as platelet rich plasma (PRP) and bone marrow concentrate (BMC) injections hold promise as nonsurgical alternatives in some cases.
Causes of a shoulder rotator cuff tear
Tendons and muscles connecting the upper arm bone to the shoulder blade comprise the rotator cuff and are located in low blood-supply areas, meaning they are more prone to wear and tear as the body ages. This makes a rotator cuff tear, when one or more of the tendons is ripped apart, a common injury later in life.
As the rotator cuff tendons become weaker, they are more susceptible to injury and tearing from everyday activities like lifting objects overhead. Rotator cuff tears can be categorized as either degenerative (happening over time) or acute (suddenly from trauma).
Rotator cuff tears are seen more often in middle-aged or older patients and often develop gradually, which would be a degenerative tear. Rotator cuff tears can also occur suddenly, in particular from trauma such as bracing the body during a fall or lifting extremely heavy objects with the arm extended. This would be categorized as an acute tear.
Rotator cuff tears can be a partial tear, meaning the tendon is NOT completely severed but the tissue is damaged. A full-thickness tear (complete tear) splits the tissue in two. The tendon often tears off where it attaches to the humerus (upper arm bone).
Generally, large acute tears resulting in shoulder dysfunction are treated with expeditious repair in order to restore shoulder function. Partial or small degenerative tears are often successfully treated utilizing non-surgical strategies to manage symptoms and improve function.
Symptoms of a shoulder rotator cuff tear
Intense pain, weakness and a popping sensation can occur at the time of injury. However, it is possible to tear the rotator cuff and not experience acute symptoms.
The main symptoms of a rotator cuff tear come after the initial injury and include:
- Difficulty moving the shoulder and arm (especially moving the arm out and away from the side)
- A snapping or cracking sound may also accompany shoulder movement after the injury
- Pain at night in shoulder.
If the tear is only partial, dull pain with minor difficulty moving the arm is usually the result. A complete tear brings a higher level of pain and the inability to move the arm correctly. In the case of complete rotator cuff tears, intense pain is accompanied by the inability to raise the arm away from the side.
Treatment of a shoulder rotator cuff tear
In roughly half of patients, nonsurgical treatments can relieve pain and improve the function of the shoulder. This does not necessarily reattach a torn tendon, but can provide good pain and function improvement. Reattachment of the tendon generally requires surgery.
Nonsurgical treatment for rotator cuff tears
Initial treatment for shoulder rotator cuff tears includes rest, alternating ice and heat, and anti-inflammatory medication to control the pain. This can be followed if needed by physical therapy or exercises to regain motion after the pain has subsided. Patients should talk to their pharmacist before purchasing anti-inflammatories, as they may interact with other medications and medical conditions.
If the above treatments don’t relieve pain, a cortisone injection may help. Cortisone is a steroid hormone that works very well to reduce inflammation.
Orthopedists can treat partial or degenerative tears with injections such as cortisone or other new biological techniques such as platelet rich plasma (PRP), combined with physical therapy. PRP injections involve taking concentrated platelets from the patient’s blood and injecting them into the damaged tendon(s). This is believed to help rebuild the damaged soft tissue to aid in the healing process and reduce pain.
Surgery for torn rotator cuffs
Orthopedists generally recommend surgery when:
- Pain continues after nonsurgical treatments
- Symptoms remain after 6-12 months
- The tear is large (> 3cm)
- A recent injury caused the tear
- The person has considerable weakness and significant loss of function
- Pain is affecting quality of life or sleep.
Although symptoms of partial tears usually decrease over time with conservative treatment, most complete rotator cuff tears will require surgery to reattach the torn tendons to the upper arm bone. With complete rotator cuff tears, rotator cuff repair surgery within three months of the injury is advisable.
Surgery is performed in an outpatient setting. Orthopedic surgeons have several options in how they surgically repair the tendon and will discuss these with the patient beforehand. The surgery is usually followed by several months of diligent physical therapy to recover the full range of motion in the shoulder and arm.
Patients experiencing pain and discomfort in the shoulder, or other symptoms of a torn rotator cuff, should contact us to request an appointment. Our orthopedic surgeons will discuss the diagnsosis and treatment options that can optimize recovery from the injury.