Torn Rotator Cuff
The rotator cuff is made up of many muscles and tendons that surround the shoulder joint. They work to stabilize the joint and keep the ball of the humerus (upper arm bone) in the shoulder socket.
What is the rotator cuff?
The rotator cuff is made up of four muscles that extend as tendons to cover the head of the humerus. Their function is to aid in the lifting and rotation of the arm. The rotator cuff is lubricated by a bursa (a fluid-filled sac) positioned between the cuff and the bone at the top of the shoulder. Sometimes, rotator cuff injuries can cause inflammation of the shoulder bursa, a condition known as bursitis.
Rotator cuff tears
Rotator cuff tears are very common. Most rotator cuff injuries begin as wear or fraying of the tendons, later progressing to a tear or partial tear.
Partial or incomplete tears involve only part of the tendon, leaving a portion of the tendon still attached. Full-thickness or complete tears describe injuries where the tendon has been completely detached from the bone.
Rotator cuff tears can occur gradually with aging. These types of injuries are a result of repetitive movement that puts stress on the tendon, bone spurs that rub on the tendon or reduced blood supply to the shoulder joint.
Most rotator cuff injuries occur in adults over age 40 and are most common in the dominant arm.
Symptoms of rotator cuff tears
Symptoms that point to a rotator cuff injury include the following:
- Deep ache in the shoulder joint that is often worse at night, especially when lying on the injured side
- Pain or difficulty in reaching overhead or behind the back
- Arm weakness on the affected side
Not all rotator cuff tears are painful, but when pain is present, it may become worse with time.
Diagnosing rotator cuff tears
Diagnosis of rotator cuff injuries begins with a physical examination. Your orthopedic specialist will check your shoulder for signs of deformity, tenderness at the joint site, arm weakness or limited range of motion.
Other tests that may be recommended include:
- X-ray – although the soft tissue of the rotator cuff cannot be visualized on x-ray, the test can identify bone spurs or arthritis that may contribute to the problem
- Ultrasound – this diagnostic test can help to identify soft tissue injuries
- Magnetic resonance imaging (MRI) – used to evaluate the structures within the shoulder joint and allow the orthopedic surgeon to visualize any abnormalities
Treatment of rotator cuff tears
Rest is the first step in treatment of rotator cuff tears. Continuing to use the arm and shoulder normally can result in extension of the injury. In addition to rest, your doctor may suggest non-steroidal anti-inflammatory medications and physical therapy to strengthen the shoulder.
If conservative treatment methods are not helpful or pain continues, the next step may be steroid injections administered directly into the joint.
Some rotator cuff injuries require surgical repair. Surgery is usually reserved for patients who have suffered an acute injury, whose pain has persisted for 6 months or longer, those with significant weakness or restricted movement or in the case of a large tear when reattachment would likely be successful because of healthy surrounding tissue.
There are many surgical repair options including arthroscopic repair and open procedures. Your orthopedic surgeon will discuss the various options and recommend the best one for your particular situation.
Extremely severe rotator cuff injuries may require shoulder joint replacement surgery.