Rotator Cuff Tears

A rotator cuff injury occurs when one or more of the tendons that make up the rotator cuff tear, and the tendon is not fully attached to the humerus anymore.

Many times, the tendon starts to fray, and as the damage to the rotator cuff worsens, the tendon can completely tear.

Anatomy

The rotator cuff is a group of muscles and tendons that surround your shoulder joint and keep your arm in the shoulder socket. The rotator cuff attaches to the upper arm bone (humerus), and it helps you to be able to lift and rotate your arm.

Between the rotator cuff and the top of your shoulder, there is a lubricating sac called a bursa, which allows the rotator cuff to glide smoothly and freely when you move your arm. If you have a rotator cuff injury, the bursa can also become inflamed and painful.

Causes

A rotator cuff injury may be caused by a sudden traumatic event or repetitive overhead activity or a combination of the two.

Most rotator cuff injuries occur because of repetitive overhead activity or heavy lifting over a long period of time. This wear-and-tear happens over time and is more common in our dominant arm. Repeating the same motion with our shoulder again and again puts extra stress on the muscles and tendons of the rotator cuff. Baseball, tennis and weightlifting are sports that put people at risk for an overuse tear. But if it not just athletics that put people at risk for overuse injuries - painters, carpenters and other professionals who do repeated overhead work are also at risk.

Additionally, as a natural part of aging, our blood supply within our rotator cuff decreases over time. Without a good blood supply, our body is not able to repair tendon damage as easily as it once did. This can also lead to a tear. Something else that happens as we age is bone overgrowth/bone spurs. If your rotator cuff is rubbing against a bone spur, it will weaken the tendons and mean you are more likely to tear your rotator cuff. This is called shoulder impingement.

Most rotator cuff tears are causes by degenerative wear-and-tear and overuse, so people over the age of 40 are at the greatest risk. For a younger person, a rotator cuff tear often is caused by a traumatic injury like a fall.

Symptoms

Common symptoms of a rotator cuff tear:

• Disrupted sleep and pain at night, especially when lying on the affected shoulder
• Pain when lifting and lowering your arm; difficulty doing things like brushing your hair or reaching behind your back
• A feeling of weakness when lifting or rotating your arm
• A crackling sensation when moving your shoulder in certain positions

A rotator cuff tear that happens from a sudden, traumatic event, like a fall, will cause intense, immediate pain. It may feel like something snapped in your shoulder.

Treatment

Treatment for a rotator cuff tear typically starts out with nonsurgical, conservative options:

Nonsurgical Treatment

• Physical therapy: Physical therapy works to rebuild muscle strength in the shoulder. By strengthening the muscles that support your shoulder, you can relieve pain, improve mobility and prevent further injury.
• Anti-inflammatory medication: An anti-inflammatory medication can help reduce pain and swelling.
• Steroid injections: At times, a steroid injection like cortisone will be recommended, which can provide excellent pain relief. This relief from pain can help patients sleep better at night and facilitate their physical therapy program.

Surgical Treatment

If nonsurgical treatment options do not work, and a patient is still experiencing discomfort and pain, your surgeon may recommend surgical repair of the rotator cuff tear.

This type of surgery usually is done arthroscopically, which means the surgeon uses a smalls scope and a camera to repair the tear. This procedure can be called shoulder arthroscopy, and the patient goes home the same day as the procedure. The surgeon repairs the tear by placing sutures through the tendon.

If you need surgery to repair a rotator cuff repair, you orthopaedic surgeon will discuss the best options for your unique case.