Rotator Cuff Tears
When one or more of the rotator cuff tendons is torn, the tendon no longer fully attaches to the head of the humerus. Most tears occur in the supraspinatus muscle and tendon, but other parts of the rotator cuff may also be involved. In many cases, torn tendons begin by fraying. As the damage progresses, the tendon can completely tear, sometimes with lifting a heavy object.
There are different types of tears.
This type of tear damages the soft tissue, but does not completely sever it.
This type of tear is also called a complete tear. It splits the soft tissue into two pieces.
In many cases, tendons tear off where they attach to the head of the humerus. With a full-thickness tear, there is basically a hole in the tendon.
Cause & Symptoms
There are two main causes of rotator cuff tears: injury and degeneration.
If you fall down on your outstretched arm or lift something too heavy with a jerking motion, you can tear your rotator cuff.
This type of tear can occur with other shoulder injuries, such as a broken collarbone or dislocated shoulder.
Most tears are the result of a wearing down of the tendon that occurs slowly over time. This degeneration naturally occurs as we age.
Rotator cuff tears are more common in the dominant arm. If you have a degenerative tear in one shoulder, there is a greater risk for a rotator cuff tear in the opposite shoulder — even if you have no pain in that shoulder.
Several factors contribute to degenerative, or chronic, rotator cuff tears.
Repetitive Stress Repeating the same shoulder motions again and again can stress your rotator cuff muscles and tendons. Baseball, tennis, rowing, and weightlifting are examples of sports activities that can put you at risk for overuse tears. Many jobs and routine chores can cause overuse tears, as well. Lack of blood supply. As we get older, the blood supply in our rotator cuff tendons lessens. Without a good blood supply, the body’s natural ability to repair tendon damage is impaired. This can ultimately lead to a tendon tear.
Bone Spurs As we age, bone spurs (bone overgrowth) often develop on the underside of the acromion bone.
When we lift our arms, the spurs rub on the rotator cuff tendon. This condition is called shoulder impingement, and over time will weaken the tendon and make it more likely to tear. Risk Factors Because most rotator cuff tears are largely caused by the normal wear and tear that goes along with aging, people over 40 are at greater risk.
People who do repetitive lifting or overhead activities are also at risk for rotator cuff tears. Athletes are especially vulnerable to overuse tears, particularly tennis players and baseball pitchers. Painters, carpenters, and others who do overhead work also have a greater chance for tears. Although overuse tears caused by sports activity or overhead work also occur in younger people, most tears in young adults are caused by a traumatic injury, like a fall.
The most common symptoms of a rotator cuff tear include:
Pain at rest and at night, particularly if lying on the affected shoulder Pain when lifting and lowering your arm or with specific movements.
Weakness when lifting or rotating your arm Crepitus or crackling sensation when moving your shoulder in certain positions Tears that happen suddenly, such as from a fall, usually cause intense pain.
There may be a snapping sensation and immediate weakness in your upper arm. A rotator cuff injury can make it painful to lift your arm out to the side.
Tears that develop slowly due to overuse also cause pain and arm weakness. You may have pain in the shoulder when you lift your arm to the side, or pain that moves down your arm. At first, the pain may be mild and only present when lifting your arm over your head, such as reaching into a cupboard.
Over-the-counter medication, such as aspirin or ibuprofen, may relieve the pain at first. Over time, the pain may become more noticeable at rest, and no longer goes away with medications. You may have pain when you lie on the painful side at night. The pain and weakness in the shoulder may make routine activities such as combing your hair or reaching behind your back more difficult.
Medical History and Physical Examination
Your doctor will test your range of motion by having you move your arm in different directions.
After discussing your symptoms and medical history, your doctor will examine your shoulder. He or she will check to see whether it is tender in any area or whether there is a deformity.
To measure the range of motion of your shoulder, your doctor will have you move your arm in several different directions. He or she will also test your arm strength. Your doctor will check for other problems with your shoulder joint. He or she may also examine your neck to make sure that the pain is not coming from a “pinched nerve,” and to rule out other conditions, such as arthritis.
Other tests which may help your doctor confirm your diagnosis include:
X-rays. The first imaging tests performed are usually x-rays. Because x-rays do not show the soft tissues of your shoulder like the rotator cuff, plain x-rays of a shoulder with rotator cuff pain are usually normal or may show a small bone spur.
Magnetic resonance imaging (MRI) or ultrasound. These studies can better show soft tissues like the rotator cuff tendons. They can show the rotator cuff tear, as well as where the tear is located within the tendon and the size of the tear. An MRI can also give your doctor a better idea of how “old” or “new” a tear is because it can show the quality of the rotator cuff muscles.
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<li><span style=”color: #405268;”><strong>Keith Pitchford, MD</strong></span></li>
<li><span style=”color: #405268;”><b>Rich McClain, MD</b></span></li>
<li><span style=”color: #405268;”><b>Natasha Mandula, DPM</b></span></li>
<li><span style=”color: #405268;”><strong>Timothy Williams, PA-C</strong></span></li>
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