Rotator cuff tears, in which the musclessupporting the shoulder joint are injured due to age or injury, are one of the most common sources of shoulder pain.
Each year, more than two million people see their doctors for pain and weakness in their shoulders because of rotator cuff tears.
Rotator cuff injuries are usually treated with a combination of medication, physical therapy and rest. In about half of cases, surgery is required to restore the majority of joint function. But before you can understand the treatment plan and when surgery is required, it’s important to understand how the rotator cuff works — and the different types of injuries.
Rotator Cuff Basics
The human shoulder joint is a ball-and-socket joint: The humerus, or upper arm bone, is topped with a “ball” that clicks into a “socket,” or depression, in the scapula or shoulder blade. The joint is surrounded by the rotator cuff, which is a network of four muscles: the supraspinatus, the infraspinatus, the subscapularis and teres minor. These muscles come together to form a single tendon that covers the top of the humerus and attaches it to the scapula.
A rotator cuff tearis any situation in which these muscles are torn or damaged. Injury can occur due to age; in fact, it’s not uncommon for people over age 40 to have rotator cuff problems. The muscle tissues can weaken and deteriorate over time due to repetitive motion, reduced blood supply or bone spurs, which are overgrowths of bone that occur as we age. The rotator cuff can also be torn due to an acute injury, such as a fall. Unlike a degenerative tear, which steadily worsens over time, an acute tear happens immediately. You may hear a snapping or popping sound when your shoulder makes impact, and immediately experience weakness or limited mobility in your arm.
There are several types of rotator cuff tears as well. Some patients experience a partial tear, in which the muscular tissue is damaged, but not completely severed or unattached from the bone. A complete tear is when the tissue is completely severed, essentially putting a hole in the muscle or detaching it from the humerus. The type of tear that you have will dictate your doctor’s recommended treatment plan.
Many people with degenerative rotator cuff injuries experience increased weakness and decreased mobility over time. They may have difficulty performing daily tasks and mild pain that increases with activity — and gets worse over time. People who suffer from acute injuries will usually experience significant pain instantly and may lose most function in that shoulder. In either case, it’s important to make an appointment with an orthopedic surgeon to determine a course of action.
In either case, your doctor will perform a physical examination that will include a test of the range of motion of your shoulder, to rule out other possible causes of shoulder pain, and will usually order imaging test including X-rays and MRIs to determine the injury’s location and extent. If you have a complete tear of the tendon or any of the rotator cuff muscles, you will most likely need surgery to repair the tendon and close the hole or reattach the tendon to the humerus.
If you have a partial tear, your doctor will most likely recommend a regimen of medication, physical therapy and exercises, and limited use of the affected arm to reduce your pain and regain some of your strength in the shoulder. The tendon will not heal itself, but if the tear is small, you may be able to enjoy most of your normal activities with caution. In some cases, your doctor may recommend surgical intervention even for partial tears, especially if the pain increases or you lose additional strength and mobility in the arm
Depending on the extent of the injury and the part of the rotator cuff that needs to be repaired, your doctor may opt for traditional open repair, mini-open repair orall-arthroscopic repair. No matter which type of surgery you have, physical therapy will be part of the recovery period. It could take several months before you have “normal” function in your arm again.
Rotator cuff injuries are common, but they do not have to become a permanent source of discomfort. If you have pain in your shoulder or arms and can’t move your shoulder as you should, see your doctor as soon as possible.