Rotator cuff tears are a common shoulder injury that affects the joint’s ability to move freely. The shoulder joint is the most flexible joint in the body, and the rotator cuff plays a vital role in lifting, stabilizing, and overall shoulder function. Without a healthy rotator cuff, shoulder movement can be significantly limited.

Here’s a closer look at rotator cuff tears, including their causes, symptoms, diagnosis, treatment, and prevention.

What Is a Rotator Cuff Tear?

The rotator cuff is made up of four muscles connected to the top of the humerus (upper arm bone) via tendons. This setup is crucial for shoulder movement and stability. The rotator cuff’s tendons attach the humerus to the scapula (shoulder blade). A bursa, a lubricating sac, sits between the rotator cuff and the acromion (a bone on top of the shoulder), allowing smooth movement of the tendons. Injuries to the rotator cuff tendons can cause pain and inflammation in the bursa, leading to further discomfort and reduced shoulder mobility.

Types of Rotator Cuff Tears

Rotator cuff tears are categorized into two main types:

1. Partial Tear: The tendon is partially damaged but remains attached to the bone. It may be thinned but not fully separated.
2. Full-Thickness Tear: The tendon is either completely or partially separated from the bone.
   • Incomplete Full-Thickness Tear: A small portion of the tendon is detached.
   • Complete Full-Thickness Tear: The tendon is fully separated from the bone.

Rotator cuff tears are common, especially as people age, with around 2 million cases annually in the U.S. Many individuals might not realize they have a tear until symptoms become more noticeable.

Symptoms of a Rotator Cuff Tear

Symptoms can vary but typically include:

• Pain during activities that involve lifting the arm or moving it sideways
• Pain in the front of the shoulder that can radiate down the arm
• Discomfort when lowering the arm
• Pain that disrupts sleep, especially when lying on the affected side
• Weakness, stiffness, or a reduced range of motion when raising the arm
• Snapping or popping sensations with arm movements
• Severe pain following an injury

Chronic tears may gradually worsen, and some individuals may not initially notice the injury.

Causes of Rotator Cuff Tears

Rotator cuff tears can result from acute injuries or gradual wear and tear:

• Acute Injury: Often caused by falls or lifting heavy objects.
• Degenerative Tears: Develop over time due to:
  • Repetitive Stress: Activities like tennis or jobs requiring frequent overhead movements.
  • Reduced Blood Supply: Aging decreases blood flow to tendons, affecting repair and increasing tear risk.
  • Impingement Syndrome: Narrowing of the space between the acromion and rotator cuff can lead to rubbing, pain, and tears.

Risk Factors

Risk factors for rotator cuff tears include:

• Advanced age
• Dominant arm (tears are more common in the dominant arm)
• Occupations with overhead activities (e.g., painters, construction workers)
• Sports with overhead movements (e.g., tennis)
• Being overweight
• Smoking
• Trauma or high blood pressure
• Poor posture

Addressing modifiable risk factors, like managing weight and quitting smoking, can help reduce the likelihood of tears. However, some factors, such as age, are beyond control.

Diagnosing a Rotator Cuff Tear

Diagnosis typically involves a physical examination and imaging tests:

• X-rays: Help rule out other conditions and detect changes related to rotator cuff tears.
• Ultrasound: Effective for visualizing full-thickness tears but may miss partial tears.
• MRI: Provides detailed images of soft tissue, ideal for diagnosing rotator cuff tears.
• Arthrogram: An X-ray with contrast dye used for detecting smaller tears.

Complications of a Rotator Cuff Tear

If left untreated, rotator cuff tears can lead to complications such as:

• Re-rupture: Re-tearing of the rotator cuff
• Shoulder Stiffness: Reduced shoulder mobility
• Surgical Complications: Including infection, nerve injury, and issues with surgical hardware
• Deep Vein Thrombosis: Blood clots that can travel to the heart or lungs
• Anesthesia Risks: Complications related to anesthesia

Treatment Options

Treatment varies based on the severity of the tear:

• Non-Surgical Treatments: Include physical therapy, anti-inflammatory medications, cortisone injections, rest, and activity modification. Most rotator cuff tears can be managed without surgery.
• Surgical Treatments: Considered if non-surgical methods are ineffective. Options include:
  • Rotator Cuff Repair: Reattaching the torn tendon through open surgery or minimally invasive arthroscopy.
  • Rotator Cuff Debridement: Removing inflamed tissue without repairing the tendon.
  • Muscle Transfers: Using other muscles to restore shoulder function for irreparable tears.
  • Shoulder Replacement: For severe tears associated with shoulder arthritis, a reverse shoulder replacement may be necessary.

Rehabilitation After Surgery

Rehabilitation is crucial and typically involves:

• Immobilization: Using a sling or immobilizer for 4-6 weeks
• Cryotherapy: To reduce pain and inflammation
• Physical Therapy: Progressing from passive to active exercises through different healing stages— inflammation, repair, and remodeling.

Prevention

To reduce the risk of rotator cuff tears:

• Warm up before exercise
• Use proper lifting techniques
• Engage in shoulder-strengthening exercises
• Maintain good posture
• Avoid smoking and manage your body weight

Summary

Rotator cuff tears can range from mild to severe and impact daily activities. Early diagnosis and treatment, often starting with non-invasive methods, can help restore function and reduce pain. For severe cases, various surgical options are available to address different types of tears and patient needs.