Rotator Cuff Tears
What Are Rotator Cuff Tears?
A rotator cuff tear is an injury to the set of muscles and tendons that connects the shoulder socket to the ball of the shoulder joint. The rotator cuff is comprised of tendons and muscles that work together to stabilize the shoulder and allow for a wide range of arm movements.
Rotator cuff tears commonly occur because the tendons have been weakened through the aging process, degeneration, or trauma. The tendons and muscles of the rotator cuff are located in low blood-supply areas, meaning they are more prone to wear and tear as the body ages. As the rotator cuff tendons become weaker, they are more susceptible to injury and tearing from everyday activities like lifting objects overhead.
A rotator cuff tear can cause pain and weakness in the shoulder, making it difficult to perform daily activities and significantly impacting quality of life. Tears can occur from repetitive rubbing (impingement), degeneration of the tendon, or from trauma such as falls or shoulder dislocation.
Types of Rotator Cuff Tears
Partial Tear
A partial tear means the tendon is not completely severed, but the tissue is damaged. If the tear is only partial, dull pain with minor difficulty moving the arm is usually the result. Partial tears may not require surgery and can often be managed with conservative treatment.
Full-Thickness Tear (Complete Tear)
A full-thickness or complete tear splits the tissue in two. The tendon often tears off where it attaches to the humerus (upper arm bone). A complete tear brings a higher level of pain and the inability to move the arm correctly. In the case of complete rotator cuff tears, intense pain is accompanied by the inability to raise the arm away from the side.
Degenerative Vs. Acute Tears
Rotator cuff tears can be categorized as either degenerative (happening over time due to wear and tear) or acute (suddenly from trauma such as a fall or injury). Age-related degeneration is a common cause, making the tendons more vulnerable to injury during normal activities.
Symptoms
Intense pain, weakness, and a popping sensation can occur at the time of injury. However, it is possible to tear the rotator cuff and not experience acute symptoms immediately. The main symptoms of a rotator cuff tear include:
- Pain in the shoulder, especially when lifting the arm or reaching overhead
- Tenderness & weakness in the shoulder and difficulty moving the arm
- Pain during sleep, particularly when lying on the affected shoulder
- Difficulty raising the arm away from the side of the body
- A popping or cracking sensation in the shoulder
Nonsurgical Treatments
In roughly half of patients, nonsurgical treatments can relieve pain and improve the function of the shoulder. While conservative treatment does not necessarily reattach a torn tendon, it can provide good pain relief and functional improvement. Treatment is dictated by the symptoms and the nature of the tear.
Rest & Activity Modification
Initial treatment for rotator cuff tears includes rest and avoiding activities that aggravate the shoulder. This allows the inflammation to decrease and gives the tissue time to begin healing.
Ice & Heat Therapy
Alternating ice and heat applications can help reduce inflammation and pain. Ice is particularly helpful in the acute phase to reduce swelling, while heat can help relax tight muscles and improve circulation during recovery.
Medications
Anti-inflammatory medications can help control pain and reduce inflammation. Patients should talk to their pharmacist before purchasing anti-inflammatories, as they may interact with other medications and medical conditions.
Physical Therapy
Once pain has subsided, physical therapy or exercises can help regain motion and strengthen the muscles around the shoulder. A physical therapist will design a customized program to restore range of motion, improve strength, and enhance shoulder stability. Symptoms of partial tears usually decrease over time with conservative treatment and dedicated physical therapy.
Injection-Based Therapies
Injection-based therapies, including corticosteroid injections and orthobiologic injections, hold promise as nonsurgical alternatives in some cases. These can provide pain relief and potentially promote healing of the damaged tissue.
Surgical Treatments
Most complete rotator cuff tears will require surgery to reattach the torn tendons to the upper arm bone. Shoulder surgeons generally recommend rotator cuff surgery when pain persists despite nonsurgical treatments, symptoms continue for 6 – 12 months, or the tear is large (greater than 3 cm). Surgery may also be advised when the injury is recent, weakness or loss of function is significant, or pain is interfering with sleep and overall quality of life. With complete rotator cuff tears, rotator cuff repair surgery within three months of the injury is advisable for optimal outcomes. Surgery is typically performed in an outpatient setting.
Arthroscopic Rotator Cuff Repair
Arthroscopy is a minimally invasive surgery, sometimes called keyhole surgery, specifically designed for examining and repairing the inside of a joint using a thin tube with a camera called an arthroscope. The surgeon can repair the rotator cuff using small instruments inserted through the arthroscope. This technique typically results in less pain and faster recovery compared to open surgery.
Open Rotator Cuff Repair
For larger or more complex tears, an open surgical approach may be necessary. This involves a larger incision to access and repair the damaged tendon. Orthopedic surgeons have several options for how they surgically repair the tendon and will discuss these with the patient beforehand.
Debridement
A smaller tear may only need a debridement procedure that smooths and trims the damaged tissue. This can help reduce pain and improve function without requiring a complete tendon repair.
Superior Capsular Reconstruction
For irreparable rotator cuff tears, a superior capsular reconstruction may be an option. This technique involves placing a tissue graft (either harvested from the patient or from a donor) to replace the function of the rotator cuff. This can be done arthroscopically and offers an alternative to shoulder replacement for patients with severe tears that cannot be directly repaired.
Postsurgical Rehabilitation
Surgery is usually followed by several months of diligent physical therapy to recover the full range of motion in the shoulder and arm. After a period of healing and rehabilitation, most people respond very well and make a good recovery after surgery. The shoulder may be immobilized in a sling for several weeks to protect the repair while healing occurs.