Rotator Cuff Tears

Shoulder pain and weakness can greatly impact your life and limit arm function. There are many reasons for shoulder pain. One common cause of shoulder pain is a rotator cuff tear. One study showed that almost 2 million people were seen for rotator cuff tears in the US in 2013.

To understand rotator cuff tears, we need to understand the anatomy around the shoulder. The shoulder is a ball and socket type joint. The scapula forms the socket of the shoulder where the proximal humerus resides. The rotator cuff is a group of four muscles that attach from the scapula to the humerus by way of tendons. These muscles help to keep the ball of the humerus within the shoulder joint and provide shoulder stability. They also assist with the motion to flex, externally rotate, and internally rotate the shoulder.

Rotator cuff tears do not occur in the muscle but occur in the tendons that attach the muscles to the bones. They can be characterized as partial tears, where the tendon is damaged but not completely severed, or full thickness tears, where a portion of the tendon is completely severed. There is a fluid filled space above the rotator cuff known as a bursa that can be a pain generator in rotator cuff tears as well. It often becomes inflamed when there is a tear and leads to further shoulder pain.

Rotator cuff tears are usually classified as acute tears or chronic degenerative tears. An acute tear is one that occurs abruptly, usually because of injury. Chronic degenerative tears result from the tendon slowly wearing out or fraying over time. Chronic degenerative tears are more common than acute tears.

What are the common symptoms experienced with rotator cuff tears? Pain is often felt around the lateral aspect (deltoid region) of the upper arm or shoulder. This pain can radiate to the elbow but usually will not radiate below the elbow. Often the pain occurs when lifting your arm above the shoulder or lowering the arm from a raised position above the shoulder. Pain at night while sleeping is very common. Weakness when lifting or rotating the arm is also common. You may also feel catching or popping around the shoulder when moving the shoulder through certain positions.

If you experience such symptoms and they are worsening, it is recommended that you see your primary care doctor or an orthopedic surgeon for further work up.

If you are found to have a rotator cuff tear, often non-surgical management can help alleviate pain and symptoms. This includes rest, avoidance of activities causing pain, physical therapy to work on the range of motion and strengthening of the remaining tendons around the shoulder.

Nonsteroidal anti-inflammatory medications can help the shoulder to feel better. If more severe pain, steroid injections around the shoulder often will help alleviate symptoms too. However, care must be taken with steroid injections as they can weaken the rotator cuff further—this should be discussed with your physician.

While pain can sometimes be alleviated by nonsurgical treatment, rotator cuff tears usually do not heal without surgery. Signs that may indicate it is time to consider surgical management include an acute rotator cuff tear, symptoms lasting over 3-6 months, being diagnosed to have a large tear through exam and imaging, and significant weakness or loss of function in the shoulder.

After repair, recovery can take 3-4 months to allow tendons to heal fully and to regain motion and strength. Many have significant pain relief and significant functional improvement after surgery.

If you are having these types of symptoms, they should be discussed further with your doctor.