What is a Rotator Cuff Tear? 

A rotator cuff tear is a common injury, often seen in sports or in jobs involving repetitive arm motions such as painting. A rotator cuff tear occurs when one or more of the tendons no longer attaches to the head of the humerus. The rotator cuff is a group of four muscles and tendons that stabilize the shoulder joint by keeping the head of the humerus (upper arm bone) within the shallow shoulder socket. The rotator cuff also facilitates lifting and rotational movements of the arm. A rotator cuff tear may be partial – when the tendon is damaged but not completely severed – or complete – when the entire tendon separates from bone.

Baptist Health is known for advanced, superior care for patients with orthopedic conditions and the diagnosis, treatment and management of rotator cuff tears. You will appreciate timely appointments and a professional, friendly atmosphere where we take time to listen to your concerns. At Baptist Health, you have access to the region’s most comprehensive, multidisciplinary team of specialists and innovative therapies, including many available only through specialized clinical trials. In every way, we work to demonstrate the utmost in excellent care to those who trust us with their health.

Rotator Cuff Tear Signs and Symptoms

Symptoms of a rotator cuff tear can include:

• A crackling sensation when moving the shoulder.
• Intense pain and a snapping sensation (if the tear is sudden, like from a fall).
• Difficulty raising the arm
• Weakness in the shoulder

Rotator Cuff Tear Diagnosis

If a rotator cuff tear is suspected, a physical examination will be performed to assess muscle strength and range of motion and questions will be asked about symptoms. Advanced diagnostic procedures and technology are utilized to effectively diagnose, determine treatment and monitor the condition. Common diagnostic procedures can include:

• Magnetic resonance imaging (MRI): A large magnet, radio waves and a computer are used to produce pictures of bone and soft tissues, including tendons. An MRI can show a rotator cuff tear, where the tear is located within the tendon and the size of the tear.
• X-rays: A common imaging test of bones or joints. Soft tissue doesn’t show up on X-rays, but it can show if the top of your arm bone (humeral head) is pushing into the rotator cuff space.
• Ultrasound: An ultrasound device can show if there is swelling or tears in soft tissues like tendons and muscles and the bursas of the shoulder.

Rotator Cuff Tear Causes

A rotator cuff tear injury can be caused by happens over time from normal wear and tear, but it also can happen suddenly with activities like a fall or heavy lifting, therefore a rotator cuff tear can be acute or degenerative. An acute tear may stem from a fall or occur from lifting something too heavy. An acute tear can also occur with other shoulder injuries, such as a broken collarbone or dislocated shoulder. Degenerative tears are more common in the dominant arm. 

Risk Factors

Risk factors that can contribute to a rotator cuff tear include:

Age: The risk of developing a degenerative rotator cuff tear increases with age. Rotator cuff tears are most common in people older than 40.

Certain sports: Athletes – like baseball pitchers, archers and tennis players – who use repetitive arm motions are at a greater risk of developing a rotator cuff tear.

Family history: Rotator cuff injuries sometimes develop in many members of the same family, indicating a genetic component.

Some occupations: Carpenters, house painters and other people who perform repetitive overhead work are at risk for rotator cuff tears.

Prevention

Not all rotator cuff tears are preventable, but there are things you can do to reduce your risk.

Protect yourself: Practice good posture, avoid lifting objects that are too heavy for you, especially over your head, and be careful playing sports where the risk of falls or shoulder overuse is likely.

Take care on the job: If your job entails repetitive overhead tasks, take frequent breaks, ice your shoulder when possible and take nonsteroidal anti-inflammatories (NSAIDs) if you experience pain or swelling in the shoulder.

Rotator Cuff Tear Prognosis

Most people with rotator cuff tears can heal, regain strength and function, and reduce pain with nonsurgical treatment.

Rotator Cuff Repair and Recovery

Rotator cuff repair depends on the type of tear, its size and location. Nonsurgical and conservative treatments are effective for many people and are often tried first. Typical rotator cuff repair treatments include:

Nonsurgical Rotator Cuff Repair

• Rest and Activity Modification: Temporarily avoiding overhead activities, or others that cause shoulder pain, can help relieve symptoms. The physician may also prescribe a sling to keep the shoulder in one position, allowing it to rest.
• NSAIDs: Non-steroidal anti-inflammatory drugs, like ibuprofen or naproxen, may be prescribed or acquired over the counter to reduce pain and swelling.
• Physical Therapy/Strengthening Exercises: Certain exercises can help restore movement and strengthen the shoulder. A physician or physical therapist can provide you with a program of stretches to improve flexibility and strengthening exercises to build the support muscles of the shoulder, relieve pain and prevent further injury.
• Steroid Injections: If rest, medications and physical therapy don’t control pain, an injection of a local anesthetic and a cortisone preparation may be helpful for some people.

Surgical Rotator Cuff Repair

If pain does not improve with nonsurgical management, surgical repair of the rotator cuff tear may be considered. Surgery to repair a torn rotator cuff typically involves reattaching the tendon to the head of humerus. Surgery may be the best option if symptoms last more than six months, the tear is large but surrounding tissue is healthy, a person is experiencing significant weakness and loss of function, or if the injury was acute and severe. Surgery options include:

• Arthroscopic: A small camera is inserted into a small shoulder incision for visualization and tiny instruments are used to fix the tear. Recovery time will likely be shorter than it would with another type of surgery.
• Open: The surgeon makes a larger incision and larger instruments are used to repair the tear.
• Mini-Open: Both arthroscopic and open methods are used. The surgeon first uses the arthroscope for visualization and then repairs the tear with the larger instruments.
• Shoulder Replacement: If necessary, shoulder replacement surgery may be recommended. Shoulder replacement surgery includes total shoulder replacement or reverse shoulder replacement.

Recovery

• After surgery, a sling may be used for four to six weeks with instructions to take the sling off several times a day and move the elbow, wrist and hand.
• An ice pack is used for 20 to 30 minutes five times per day to help decrease post-operative pain and swelling.
• Most important: Do not lift the arm at the shoulder until the surgeon says it’s OK.

Complications

Without treatment, rotator cuff tears can lead to permanent stiffness or weakness and may result in progressive degeneration of the shoulder joint.