Rotator Cuff Tears

One of the most common shoulder conditions for people over 40 years old is a rotator cuff tear. The rotator cuff is comprised of the muscles and tendons that surround the top of the upper arm bone (humerus) and hold it in the shoulder joint. A tear may result suddenly from a single traumatic event or develop gradually because of repetitive overhead activities.

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Symptoms

There are many symptoms for a rotator cuff tear:

  • Recurrent, constant pain, particularly with overhead activities
  • Pain at night that prevents you from sleeping on the affected side
  • Muscle weakness, especially when lifting the arm
  • Catching, grating or cracking sounds when the arm is moved
  • Limited motion
  • Usually occurs in the dominant arm (right shoulder for right-handed people; left shoulder for left-handed people)
  • May be triggered by a specific incident

Causes and Risk Factors

  • Repetitive overhead motion, such as pitching or painting a ceiling
  • Heavy lifting
  • Trauma from excessive force, such as a fall
  • Degeneration due to aging or reduced blood flow to the tendon
  • Narrowing of the space (acromioclavicular arch) between the collarbone (clavicle) and the top portion (acromion) of the shoulder bone (scapula).
  • Rubbing of the cuff surface by the top of the shoulder bone.
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Diagnosis

Your doctor will generally discuss your symptoms and the circumstances around the time when they first appeared. He or she may ask if you had any recent injuries or accidents.

During a physical examination, the doctor generally will look at the top and back of your shoulder to see if the muscles have begun to shrink (atrophy). You may be asked to move your arm in several directions, or to hold it in various positions. X-rays and other diagnostic imaging scans can help the doctor see any problems with the bones. One such test is an arthrogram, in which a dye is injected into the joint before the X-ray is taken. Other imaging tests include magnetic resonance imaging (MRI) and ultrasound.

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Treatments

There are two types of rotator cuff tears:

  • Partial, which is a tear that doesn't completely sever the tendon. This type of injury may respond well to nonsurgical treatments. If it does not, surgery may be done.
  • Full thickness tears, in which the tendon is torn into two pieces. This type of tear requires surgery to repair.

The specific treatment your doctor uses will depend on your injury, the amount of pain you are having and your ability move and use your arm.

Usually the first approach to treatment is conservative treatment - care that does not involve surgery. This type of treatment involves resting your arm and shoulder, taking drugs to reduce the swelling and help control pain, physical therapy or corticosteroid injections can help reduce pain but cannot be repeated frequently because they can also weaken the tendon.

Ultrasound can enhance the ability of drugs that are applied to the surface of your body. It also has warming effects that may help healing.

There are several surgical options to treat rotator cuff tears, depending on the size, depth, and location of the tear. If other problems with the shoulder are discovered during the surgery, they will be corrected as well.

Arthroscopy, in which miniature instruments are inserted into small incisions, can be used to remove bone spurs or inflammatory portions of muscle and to repair lesser tears.

A mini-open repair that combines arthroscopy and a small incision can be used to treat full-thickness tears.

Open surgery may be required in more severe cases to repair the injured tendon. Sometimes a tissue transfer or a tendon graft is used.

Shoulder joint replacement is also an option for extreme cases.

It takes some time to recover from shoulder surgery. Full functioning may not return for six months or more. Your doctor will recommend a program of exercises to strengthen and restore motion, including physical therapy. Although every case is unique, surgery can relieve pain for most people and rehabilitation can restore functional range of motion.

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