Rotator Cuff Tears

The rotator cuff, which is located in the shoulder, is made up of four muscles and tendons that connect the humerus (large bone of the upper arm) to the scapula (shoulder blade): supraspinatus, infraspinatus, teres minor, and subscapularis muscles. Together, the tendons and muscles work to assist with stabilization of the shoulder during movement, as well as rotation of the upper extremity. Injuries to the rotator cuff are caused by repetitive, overhead motions, traumatic injuries and age-related wear and tear. Due to decreased blood supply, rotator cuff injuries may require increased time for healing.

There are two types of tears. The partial tear has damage to the soft tissue, but the muscle or tendon has not been split. When a person has a full-thickness tear, the muscle or tendon has been completely torn.

Symptoms of rotator cuff injury may include limited range of motion in the shoulder, pain that worsens as the arm is lifted, weakness and tenderness in the shoulder, pain that radiates down the arm towards the elbow, cracking sounds when moving the arm, and pain when sleeping on the affected shoulder. Tears that develop over time (chronic) may initially only present with pain during overhead movement, and temporary relief may be found from over-the-counter medications. When the aggravating movements continue, the tear can become larger and the pain more debilitating. This will begin to affect a person’s quality of life, as the ability to participate in overhead activities, including washing hair, cooking, and putting away dishes/laundry, will decrease. Diagnosis of a rotator cuff injury is done through physical examination and imaging tests, including X-ray, MRI and ultrasound.

Treatment options for rotator cuff tears vary, based on the extent of the damage. Conservative, non-surgical options are used to treat partial tears and include rest, pain relieving medications, steroid injections into the shoulder joint, range of motion exercises, and physical therapy. The healing regimen for moderate cases of rotator cuff injuries includes immobilization, anti-inflammatory medications, and cold therapy. unfortunately, most instances of decreased strength do not improve without surgery. More severe rotator cuff injuries, such as full-thickness tears, may require surgery to repair the rotator cuff.

Typical symptoms of a torn rotator cuff include arm weakness, a dull ache in the shoulder, pain when raising and lowering the arm, atrophy of the muscles in the shoulder, pain when lying on the affected shoulder, and a cracking sensation in the shoulder when the shoulder is moved.

A torn rotator cuff is diagnosed through a physical examination. The examination will include assessing the range of motion of the shoulder, tenderness in the shoulder and arm strength. An X-ray or MRI may also be necessary to confirm the diagnosis. Treatment options for rotator cuff tears includes rest, activity modification, anti-inflammatory medications, strength and stretching exercises and the use of an immobilization device. Surgery may be necessary to reattach the torn tendon in severe cases.