Rotator Cuff Tear of the Shoulder
What is a rotator cuff tear?
Rotator cuff tears are among the most common conditions affecting the shoulder. The injury involves any type of irritation or damage to the four tendons of the rotator cuff muscle, which covers the shoulder joint and helps raise and rotate the arm.
There are two different types of rotator cuff tears. A partial tear damages the soft tissue, but does not completely sever it. A complete tear, also called a full-thickness tear, splits the soft tissue into two pieces. In many cases, the tendons tear off where they attach to the head of the humerus (the upper arm bone).
How does a rotator cuff tear occur?
Rotator cuff tears can occur from injury or degeneration.
Common causes of acute tears include falling on an outstretched arm, lifting something heavy with a jerking motion, and repetitive arm activities — especially those done overhead, such as throwing a baseball, serving in tennis or lifting objects onto high shelves.
In older adults, normal wear and tear can break down collagen in the rotator cuff tendons and muscles, making them more prone to degeneration and injury. Calcium deposits or arthritic bone spurs can pinch or irritate the rotator cuff.
What are the symptoms of a rotator cuff tear?
Acute tears from massive trauma, such as a fall, usually cause intense pain. There may be a snapping sensation and immediate weakness in your upper arm.
The most common symptoms of a chronic rotator cuff tear include:
- Pain and tenderness, particularly if lying on the affected shoulder
- Pain is generally in the lateral aspect of the upper arm
- Night pain
- Pain when lifting the arm overhead and lowering your arm or with specific activities such as brushing your hair or reaching behind your back
- Weakness when lifting or rotating your arm if the tear is large
- A crackling sensation when moving your shoulder in certain positions
How is a rotator cuff tear diagnosed?
In addition to a physical exam, MRI is the most effective test to confirm the diagnosis of a torn rotator cuff.
What is the treatment?
Surgery is used to treat a rotator cuff tear if the tear is retracted greater than 1.0cm, or if nonsurgical treatment – rest, physical therapy, non-steroidal anti-inflammatory drugs (NSAIDs) and cortisone injections – has failed to improve the pain and provocative symptoms.
In younger and middle-aged patients, surgery is the treatment of choice for a full-thickness tear if the tendon is repairable. Partial tears often respond to conservative treatment. The symptoms may improve along with function when treated non-operatively, however the partial tears do not experience healing back to their normal state without surgery. For older patients with natural degeneration, the decision to have surgery is based on a number of factors including symptoms, function, repairability and tissue quality.
Thanks to advancements in arthroscopic techniques and materials, surgeons can perform successful rotator cuff repairs on patients of all ages and activity levels using very small incisions. This minimally invasive approach offers numerous benefits including less muscle and tissue trauma, less bleeding, and less pain. Tears of all sizes can be repaired arthroscopically depending on tissue quality and chronicity of the tear. However, the time required for rotator cuff repair healing is similar to open surgery as the rate limiting step is healing of the cuff repair itself.