The shoulder is the most mobile joint in the body. Its ability to function properly relies on the strength of the tendons and ligaments that allow it to move. The rotator cuff is one of the most crucial components of the shoulder.
As a group of tendons that connect the four muscles of the upper shoulder to the bones, the rotator cuff enables the muscles to lift and rotate the bone of the upper arm (the humerus.) These tendons are located under the acromion – a part of the shoulder blade – and as such, are prone to damage. When the rotator cuff is damaged, it tears, and this tearing can cause extreme pain and compromise the strength of the shoulder, limiting the use of the shoulder and the entire arm.
Rotator Cuff Tear Symptoms
A torn rotator cuff can result from a traumatic event, or it can tear slowly over time. The primary symptom of a torn rotator cuff is pain and reduced range of motion; however, other symptoms may present and can vary. Additional symptoms of a torn rotator cuff include:
- Difficulty sleeping, especially when lying on the affected shoulder
- Weakness in the arm
- Restricted motion and difficulty completing tasks that require reaching, such as combing your hair, or trying to scratch your back
- A ‘catching’ feeling in the shoulder
- A ‘locking’ feeling in the shoulder
- Feelings of instability in the shoulder and/or arm
Causes & Risk Factors
A torn rotator cuff can either be the result of a traumatic injury to the shoulder or can be caused by the progressive degeneration, (wear and tear) of the tendons. Common causes of a torn rotator cuff include:
- Repetitive overhead activity
- Repetitive heavy lifting
- The development of bone spurs around the shoulder blade
The following factors can increase the risk of a torn rotator cuff:
As you age, your risk of tearing your rotator cuff increases. This condition is most common in people over the age of 35.
Participation in Certain Sports
Sports that require the use of repetitive arm motions can increase the chances of tearing the rotator cuff. These sports include but are not limited to, baseball, tennis, archery, golfing, and surfing, and basketball.
Manual Labor Occupations
These types of jobs often require the use of repetitive, overhead arm movements, which can damage the rotator cuff. House painters, construction workers, and carpenters, for example, are susceptible to torn rotator cuffs. In addition, firefighters and law enforcement officers are also susceptible.
There may be a genetic component that can increase the chances of developing a torn rotator cuff. Individuals who have family members who have developed this condition may be more apt to develop it themselves.
Although x-rays and MRIs are extremely valuable diagnostic tools for identifying a torn rotator cuff, history and physical examination is by far the most valuable way to evaluate the cause of shoulder pain. This examination will allow the doctor to determine the cause of the pain, and also evaluate if it is coming from locations other than the shoulder, such as the neck or the heart.
Treatment & Procedure
When properly diagnosed, the majority of shoulder pain can be treated successfully without surgery. Although some rotator cuff tears need to be fixed, many of these can also be treated without surgery.
This may include altering the activities that the patient participates in, physical therapy, anti-inflammatory medications, and injections.
Arthroscopy is a minimally-invasive surgical treatment for a torn rotator cuff. Arthroscopic treatment of rotator cuff tears allows for a much more thorough evaluation of all of the structures of the shoulder. An experienced shoulder surgeon will be able to fix even the most complex rotator cuff tears arthroscopically.
Dr. O'Grady uses the latest surgical techniques and methods such as the Rotation Medical Rotator Cuff Repair System.
There are four phases of recovery in returning to activities and sports:
- Immediate Post-Surgical Phase (Day 1-10)
- Protection Phase (Day 11- Week 6)
- Intermediate Phase (Week 7-14)
- Return to Activity Phase (Week 23-30)
You may experience stiffness and tenderness during recovery, especially in the first phase, which will improve with strength training and physical therapy. During each phase of recovery, it is vital to listen to the aftercare instructions provided by your medical professional.
Frequently Asked Questions
Can rotator cuff tears cause pain in other areas of the body?
While rotator cuff tear pain is primarily thought to be located in the injured shoulder, it can also radiate along the outside of your upper arm all the way down to the thumb in the case of a supraspinatus tendon injury, or down the back of the arm in the case of a subscapularis injury.
When the infraspinatus tendon is injured, you may feel pain deep within the shoulder joint all the way to the outer part of your arm and hand. In some cases, you may feel pain and tingling in your fingertips resulting from your rotator cuff injury. Dr. O’Grady and his staff at O’Grady Orthopaedics will work with you to determine the scope and severity of your rotator cuff tear so you can make informed decisions about what your next move will be.
Will a rotator cuff tear heal itself?
The long and short answer is: sometimes. Multiple variables go into determining the best course of action to maximize the success of the repair, these include age, severity and location of the tear, desired activity level, and much more. Dr. O’Grady and his staff are happy to discuss treatment options and statistical outcomes similar to your case to allow you to make an informed decision on your treatment plan.
There are non-surgical treatments that help relieve pain and improve function in the injured shoulder, including:
- Modifying or reducing activities
- Resting the shoulder
- Ice sleeves or compression wraps
- Sleeping with a support pillow
- Anti-inflammatory medications
- Steroid injections
- Physical therapy and exercises to strengthen your shoulder
Work with your orthopaedic surgeon to determine the best course of action for your rotator cuff tear and whether surgery could be beneficial. O’Grady Orthopaedics utilizes cutting-edge technology and minimally invasive procedures whenever possible so you can feel confident that you are getting expert care and the best possible treatment.
What does a rotator cuff tear look like on MRI or X-ray?
When an x-ray of the shoulder is done, your rotator cuff tear may look like a small bone spur, or even appear completely normal. MRIs of the shoulder offer more detail and a bigger picture of the nature of the injury. MRIs allow the surgeon to determine the size of the tear, where the tear is in relation to the tendon, and the age of the tear.
When does a rotator cuff tear require surgery?
Not all rotator cuff injuries or tears require surgery. Your doctor may recommend surgery if you experience persistent weakness or pain in relation to your shoulder, limited use of your arm after months of conservative treatments, or limitations in daily activities. It is best to seek a consultation with an orthopaedic surgeon to determine the best course of action.
Why does a rotator cuff injury hurt at night?
Rotator cuff injuries irritate the small pocket sitting on top of the cuff called the bursa. This area typically becomes inflamed at night, resulting in severe pain that makes it difficult to sleep, which is instrumental in helping the body fight pain and repairing the damage from the tear.