What Is Rotator Cuff Tear?
A torn rotator cuff tear is one of the most common causes of pain and disability among adults. A torn rotator cuff weakens the shoulder, inhibiting daily activities such as sleeping, dressing or combing the hair and often becomes more painful and difficult with time.
When one or more of the rotator cuff tendons is torn, the tendon is no longer fully attached to the head of the humerus. In many cases, torn tendons begin with fraying and, as the damage progresses, the tendon tears completely. The subsequent injury often associated with lifting a heavy object.
More Information About Rotator Cuff Tear
There are two different types of tears:
- Partial tear: Also referred to as an incomplete tear, it damages the tendon, but does not completely sever it.
- Full-thickness tear: This type of tear is also called a complete tear. It separates all of the tendon from the bone. With a full-thickness tear, there is basically a hole in the tendon.
There are two main causes of rotator cuff tears: injury and degeneration.
Acute Tear: If a patient falls down on an outstretched arm or lifts something too heavy with a jerking motion, the rotator cuff can tear. This type of tear can occur in conjunction with other shoulder injuries such as a broken collarbone or dislocated shoulder.
Degenerative Tear: Most tears are the result of the tendon simply wearing down over time. This degeneration naturally occurs as the body ages. Rotator cuff tears are more common in the dominant arm. If a patient has a degenerative tear in one shoulder, there is a greater likelihood of a rotator cuff tear in the opposite shoulder.
The most common symptoms of a rotator cuff tear include:
- Pain at rest particularly at night (affecting sleep), particularly if lying on the affected shoulder
- Pain when lifting and lowering the arm or with specific movements
- Weakness when lifting or rotating the arm
- Crepitus or crackling sensation when moving the shoulder in certain positions
The goal of any treatment is to reduce pain and restore function. There are several treatment options for a rotator cuff tear. Consult a doctor for the best course of treatment. The doctor will consider factors such as age, activity level, general physical health and the type of tear.
In about 80% of patients, nonsurgical treatment relieves the pain and improves/restores shoulder function.
Rest: A doctor may suggest rest and limiting overhead activities as well as prescribe a sling to help protect the shoulder and keep it immobile. Activity modification will be required to avoid shoulder pain.
- Nonsteroidal anti-inflammatory medication: Drugs like ibuprofen and naproxen reduce pain and swelling.
- Strengthening exercises and physical therapy: Specific exercises will restore movement and strengthen the shoulder. The exercise program will include stretches to improve flexibility and range of motion. Strengthening the muscles that support the shoulder can help to relieve pain and prevent further injury.
- Steroid injection: If rest, medications, and physical therapy do not relieve the pain, an injection of a local anesthetic and a cortisone preparation may be helpful. Cortisone is a very effective anti-inflammatory medicine; however, it is not effective for all patients.
The advantage of nonsurgical treatment is that it avoids the major risks of surgery, such as:
- Permanent stiffness
- Complications due to anesthesia
- Sometimes lengthy recovery time
The disadvantages of nonsurgical treatment are:
- Size of tear may increase over time
- Activities and range of general motion may need to be limited as a result
A doctor may recommend surgery if the pain does not improve with nonsurgical methods. Ongoing pain is the primary indicator for surgical candidacy. If a patient is very active and uses the arms for overhead sports or daily work, the doctor may recommend surgery.
Surgery to repair a torn rotator cuff most often involves re-attaching the tendon to the head of humerus (upper arm bone). There are a few options for repairing rotator cuff tears, and the orthopaedic surgeon will discuss them with the patient to determine the best procedure for the individual.