Rotator cuff tear

Overview

A rotator cuff tear is a partial or total split in the tendinous portion of the four muscles that connect the upper arm bone (the humerus) to the shoulder blade (the scapula). The head of the humerus is held securely but fluidly in the shoulder blade’s socket. This “ball-and-socket” joint must function correctly for you to do things that most people take for granted — such as brushing your hair and putting on your pants — without pain. Because this injury is often chronic (damage done over a significant length of time), rotator cuff tears are seen far more in people over 40.

A rotator cuff tear is the most commonly sustained sports injury, especially in baseball and swimming. Chronic rotator cuff tears are so common in swimmers that they are called “swimmer’s shoulder.” Baseball pitchers are the players most likely to sustain chronic rotator cuff tears because of the frequency and speed with which they throw the ball. However, all baseball players are vulnerable to the injury.

Acute rotator cuff tears are most frequently sustained because one has taken a fall with an arm extended or attempted to lift something with a non-fluid motion. Older people are most affected by acute rotator cuff tears, as well as chronic rotator cuff tears, because their tendons are not as tough as they once were. As people age, their tendons wear away, and the blood supply becomes less plentiful — a situation that can make a minor fall traumatic.

Anatomy of the shoulder

The shoulder, the joint in the human body with the greatest field of mobility, is composed of the following:

  • Clavicle (collarbone)
  • Scapula (shoulder blade)
  • Humerus (upper arm bone)
  • Rotator cuff (group of muscles and tendons that surround the shoulder joint, keeping the head of the upper arm bone firmly within the shallow socket of the shoulder)
  • Bursa (a lubrication sac sitting between the humerus and the acromion, the technical name for the outward end of the shoulder blade) 

Symptoms

Different types of rotator cuff tears have different symptoms. Acute rotator cuff tears cause immediate, extreme pain and the loss of a significant amount of arm strength. You may feel a “snap” in your shoulder because of an acute rotator cuff tear. Chronic tears, on the other hand, frequently start as mild pain, which may be felt only when executing a particular arm movement. However, as time goes by, this pain will become more widespread, consistent and debilitating. The following are common rotator cuff tear symptoms:

  • Pain
  • Weakness
  • Limited mobility
  • Shoulder cracking when it is put in certain positions

The symptoms of rotator cuff tears may be mistaken for the symptoms of other medical conditions such as suprascapular neuropathy and subacromial impingement syndrome. Make sure you consult a doctor to determine if you have a rotator cuff tear and get the appropriate treatment. 

Causes

There are a few causes of rotator cuff tears:

  • Acute injury – This is the least common cause of a tear. A fall from a great height or an attempt to lift a heavy object with lurching motions can cause an acute tear of the rotator cuff.
  • Chronic injury – The rotator cuff is most often torn because it has been worn down. This wearing down is the result of repetitive stress. This stress can be caused by arm motions associated with sports such as weightlifting, tennis, rowing, swimming and baseball, or with occupations such as carpentry.
  • Degenerative injury – Older people are more vulnerable to rotator cuff tears. As with all muscles, the rotator cuff loses some of its vitality as people age. Additionally, the bone spurs that frequently form on the outward ends of older peoples’ shoulder blades wear on the rotator cuff. This causes the rotator cuff to weaken (a condition known as shoulder impingement) and become more liable to tear.

Types

Rotator cuff tears can be divided into two main types (Type I strains are missing because Type I strains are non-tearing strains):

  • Type II strain – Type II strains are partial tears of the rotator cuff.
  • Type III strain – Type III strains are total tears of the rotator cuff.

The multidisciplinary team of shoulder experts at Northwell Health Orthopaedic Institute treats rotator cuff tears as well as a broad range of conditions that affect the bones.

Animated video: Partially torn rotator cuff


Related animated videos:

Treatment options

Rotator cuff tears can worsen over time, so it is important to receive treatment immediately. There are nonsurgical and surgical options for treating rotator cuff tears, depending on the severity.

Nonsurgical treatment

About 80 percent of patients tend to see success from nonsurgical treatment for this type of injury. Typical nonsurgical treatment options include:

  • Rest
  • Activity modification
  • Anti-inflammatory medications
  • Physical therapy
  • Steroid injections

Surgical treatment

If a tear is particularly advanced, continues to be painful or does not improve with nonsurgical treatment, surgery may be required. During surgical rotator cuff repair, your doctor will re-attach the tendon to the head of the humerus.

There are two types of surgical repairs: open and arthroscopic. Arthroscopic surgery is a minimally invasive procedure that allows for quicker, less painful recovery time. 

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