What is a rotator cuff injury?
The shoulder consists of the humerus (upper arm bone), scapula (shoulder blade), and clavicle (collarbone). The rotator cuff is a group of four muscles that hold the head of the humerus and scapula together. While its primary function is to help stabilize the shoulder, it also aids in rotational movement. Injuries occur when any of these structures have been damaged.
What are the most common types of rotator cuff injuries?
Tendinitis, bursitis, and tears are the three most common types of rotator cuff injuries.
Rotator cuff tendinitis, also called shoulder impingement syndrome, occurs when the tendons that connect the rotator cuff muscles to the humerus become irritated or inflamed. Similarly, bursitis occurs when bursae, or the fluid-filled pads that serve as cushions in joints, become painful and swollen. These conditions share a number of causes, including:
- Repetitive overhead movements
- Holding the arm in the same position for long periods of time
- Compressing the arm for long periods of time
- Sudden injury
Rotator cuff muscles and tendons can also be partially or completely torn. A tendon that has been partially frayed, or worn, is classified as a partial-thickness tear. By contrast, full-thickness tears range from pinpoint holes in the muscles and tendons of the rotator cuff to substantial tissue damage. This type of tear can affect one or more tendon and, in the most severe instances, completely detach rotator cuff tendons from the humeral head.
Moreover, tears are categorized as either acute tears or chronic tears depending on their cause. Acute tears result from sudden injuries such as falling on an outstretched arm or lifting a load that is too heavy. Chronic tears, also known as degenerative tears, often begin as microscopic injuries and gradually worsen over time.
What are the signs and symptoms of a rotator cuff tear?
Individuals may experience a sudden “tearing” sound and/or sensation at the time of their injury, followed by weakness in the affected arm. Other patient have a gradual decrease in shoulder motion and strength from a chronic degenerative tear.
Symptoms of a rotator cuff tear include:
- Shoulder pain
- Loss of shoulder mobility
- Weakness in the shoulder joint
- Swelling around the shoulder
- Pain with overhead activity
While symptoms can vary from mild to severe, it’s important to understand that the amount of pain associated with a tear does not necessarily correlate with its size. In fact, patients with a small, partial tear—or even no tears at all in the case of tendinitis and bursitis—can easily mistake their pain as a sign of a worse condition. Conversely, major tears may only be mildly painful and even go unnoticed. The same principle also applies to shoulder mobility.
Only an orthopaedic specialist can properly diagnose a rotator cuff tear. If you suspect an injury, it’s important to see an orthopaedic specialist as soon as possible.
What are the risk factors for a rotator cuff tear?
Overuse: Repetitive, overhead motions associated with certain sports and occupations put individuals at greater risk of chronic tears. This type of injury is particularly common in overhead sports such as: baseball, tennis, golf, volleyball, and swimming. Moreover, construction workers and those who work in similar, manual labor type fields are also at high risk of developing a chronic tear.
Arthritis: Degenerative forms of arthritis—especially osteoarthritis—will weaken rotator cuff muscles and tendons, consequently making them more susceptible to tears.
Age: Individuals over the age of 40 are more likely to develop rotator cuff tear. This is primarily due to two natural changes the body undergoes as it ages. First, less blood is supplied to the rotator cuff tendons. This diminishes the body’s ability to heal these tendons and consequently makes them more susceptible to injury. Second, bone spurs often develop on the underside of the acromion which as located at the tip of the shoulder blade. These spurs, or overgrowths, rub on rotator cuff tendons every time the arm is lifted. Over time, this can not only lead to shoulder tendinitis, but also weaken the tendon and lead to a potential tear.
How is a rotator cuff tears diagnosed?
The diagnostic process begins with a patient interview and is followed a physical examination. During the examination, the orthopaedic specialist will:
- Press on different parts of the shoulder
- Maneuver the shoulder through various positions
- Test the strength of shoulder and arm muscles
Often, a physical examination is all that is needed to diagnose a rotator cuff tear. However, a specialist may recommend imaging tests such as x-rays, ultrasound, or an MRI to help guide treatment options and confirm the size or location of the tear.
What treatments are available for rotator cuff tears?
Most rotator cuff tears can be treated with a combination of rest and physical therapy. And while conservative, non-surgical treatments can be highly effective, patients will need to demonstrate patience. Moreover, patients will need to protect their shoulder against further wear and tear, as well as additional complications, while their body heals.
Patient who do not respond to the initial nonoperative program may have their symptoms improve with regenerative medicine or surgical intervention. Regenerative medicine treatment involves injections, such as PRP (platelet rich plasma) or stem cell treatments to stimulate the body’s ability to heal itself. Surgery involves arthroscopic techniques that allow the surgeon to remove bone spurs, bursitis and inflammation. This minimally invasive technique also allows the surgeon to repair the torn tissue if needed.
The most severe rotator cuff injury, a large full-thickness rotator cuff tear, typically requires surgery. Arthroscopic rotator cuff repair, in particular, is a minimally invasive surgery that an orthopaedist may recommend to younger patients who are in otherwise good health. This form of surgery allows a surgeon to repair the patient’s damaged muscle and tendons while also minimizing overall tissue trauma.
What is the outlook on recovery?
Minor to moderate rotator cuff tears require approximately 6 to 12 weeks of rehabilitation. Physical therapy not only helps restore shoulder strength and mobility but it also prevents the build-up of scar tissue around the shoulder joint. While many patients will recover most of their shoulder strength and mobility, some patients will never fully recover.
While large rotator cuff tears are uncommon, a combination of conservative treatments and surgery has been proven to be highly effective. If left untreated, a large tear can lead to arthritis. Specifically, the combination of a rotator cuff tear and arthritis is referred to as rotator cuff arthropathy. Unfortunately, there are limited options for this condition. In the majority of cases, a shoulder replacement is necessary to restore shoulder strength, mobility, and function. It’s imperative that patients see an orthopaedic specialist immediately following an injury in order to avoid arthropathy and similar complications.
Beacon Orthopaedics and Sports Medicine offers a variety of educational material related to rotator cuff tears. The following are related articles and videos from our blog:
If you are experiencing shoulder pain, and conservative treatment options haven’t helped, schedule an appointment with Dr. Steve Hamilton for an evaluation and treatment plan personalized to you.