The rotator cuff is a series of four muscles that run from the shoulder blade (scapula) around the shoulder socket (glenoid) and attach to the ball of the shoulder (humeral head) by their tendons. Injury or degeneration (wear and tear) can result in a tear of a rotator cuff tendon. Rotator cuff tears can cause weakness and pain and, without repair, can get larger with time and may eventually become nonfunctional and irreparable.
What Is a Rotator Cuff Tear?
The muscles of the rotator cuff work to keep the humeral head centered in the socket as the arm moves. When a rotator cuff tendon tears, it affects the ability to keep the humeral head centered on the socket, which can cause weakness and pain.
As the arm elevates, the rotator cuff tendons and subacromial bursa, which sits on top of the rotator cuff, come into contact with the coracoacromial arch that serves as the bony roof of the shoulder joint. This contact can cause pain and inflammation, resulting in further rotator cuff weakness and creating a cycle of pain with repeated use of the shoulder.
Causes and Risk Factors
Causes of rotator cuff tears include:
- Direct injury to the shoulder, such as falling on an outstretched arm
- Aging or degeneration (wear and tear) of the tendon with use
- Shoulder dislocation, typically in patients over age 40
- Impingement of the rotator cuff on the coracoacromial arch (bony-ligamentous roof of the shoulder), causing fraying and wear of the tendon
- Internal impingement of the rotator cuff on the posterosuperior glenoid (socket)
Risk factors include:
- Contact sports or throwing sports
- Weightlifting and bodybuilding
- Heavy or repetitive overhead labor
- Previous injury to the rotator cuff, including impingement
- Poor physical conditioning, including strength and flexibility
- Inadequate warm-up before activities
- Inadequate protective equipment
- Increasing age
- Spurring of the acromion (bony roof of the shoulder) or Os Acromiale
- Repeated corticosteroid injections
Symptoms
Common signs and symptoms include:
- Pain along the upper arm between the shoulder and elbow
- Pain that increases when reaching out and overhead or when lifting objects
- Aching pain at rest or at night while trying to sleep
- Loss of strength
- Limited shoulder motion, especially when reaching behind for a back pocket or bra clasp
- Crepitation (a crackling sound) when moving the shoulder
Treatment
Treatment depends on the patient’s medical health and demands (activity level), the presence of arthritis, and whether the tear is reparable.
For large, possibly irreparable tears, elderly patients with low demands, or poor surgical candidates because of other health conditions, restricting activities that cause symptoms combined with physical therapy to optimize the function of the remaining intact rotator cuff muscles may be the most appropriate initial treatment.
For irreparable tears with shoulder arthritis (rotator cuff arthropathy), initial treatment is similar, except in rare cases when a reverse shoulder replacement may be warranted.
For irreparable tears that have not improved with initial activity restriction and physical therapy, arthroscopic surgery to debride (clean up) the rotator cuff and shoulder joint, release or use the damaged biceps tendon to partially repair the rotator cuff, remove the inflamed bursa, or decompress the bony space between the humeral head (ball of the shoulder) and the acromion (bony roof of the shoulder) may help relieve symptoms.
For all other symptomatic rotator cuff tears, surgery is usually recommended to repair the rotator cuff tendon back to the arm bone. Surgery may be performed arthroscopically or with an open incision. Dr. Chudik can perform arthroscopic surgery to reattach the torn tendon to the bone.
Recovery and Outcomes
Symptoms may resolve by avoiding or limiting aggravating activities and performing physical therapy exercises to strengthen the remaining intact rotator cuff muscles to compensate for the tear. However, rotator cuff tears do not heal with conservative treatment and will get larger with time. Eventually, an untreated rotator cuff tear may become nonfunctional and irreparable.
Surgery is often needed to repair the rotator cuff tear, alleviate pain, and restore function.
Following rotator cuff repair, return to full activity usually requires six to eight weeks in a sling followed by four to six months of physical therapy.
Potential complications include:
- Persistent pain that may progress to constant pain as the tear progresses
- Shoulder stiffness, frozen shoulder, or loss of motion
- Persistent weakness
- Recurrence of symptoms, especially if treated without surgery
- Inability to return to the same level of function even if the tendon is repaired
- Arthritis or rotator cuff arthropathy
- Surgical risks, including infection, bleeding, injury to nerves, shoulder stiffness, weakness, re-tearing of the rotator cuff tendon, and persistent pain
When to See Dr. Chudik
For evaluation and treatment of a rotator cuff tear, call 630-324-0402, schedule an appointment online, or email contactus@chudikmd.com.