A rotator cuff tear is a common shoulder injury that involves a tear in one or more of the tendons that make up the rotator cuff. The rotator cuff is a group of four muscles and their associated tendons that surround the shoulder joint, providing stability and allowing for a wide range of arm movements, including lifting and rotating the arm.
Anatomy of the Rotator Cuff
The rotator cuff consists of the following four muscles:
- Supraspinatus: Located at the top of the shoulder, it helps lift the arm and is the most commonly injured.
- Infraspinatus: Located at the back of the shoulder, it aids in external rotation of the arm.
- Teres Minor: Also located at the back, it assists the infraspinatus in rotating the arm outward.
- Subscapularis: Located at the front of the shoulder, it helps rotate the arm inward.
Types of Rotator Cuff Tears
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Partial Tear: This occurs when one of the tendons in the rotator cuff is damaged or frayed but not completely severed. It can involve only a portion of the tendon.
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Full-Thickness (Complete) Tear: This occurs when the tendon is completely torn, often resulting in the tendon being pulled away from its attachment on the bone. A full-thickness tear can be small or large, depending on how much of the tendon is involved.
Causes of Rotator Cuff Tears
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Acute Injury: A sudden injury, such as falling on an outstretched arm, lifting something too heavy, or a direct blow to the shoulder, can cause a tear.
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Degenerative Wear and Tear: Over time, repetitive overhead motions, such as those involved in sports (e.g., tennis, baseball) or occupations (e.g., painting, carpentry), can lead to degeneration and tearing of the tendons.
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Aging: The risk of rotator cuff tears increases with age as the tendons naturally weaken and become more prone to injury.
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Impingement: Chronic impingement, where the tendons are repeatedly pinched between the bones of the shoulder, can lead to inflammation and eventual tearing.
Symptoms of a Rotator Cuff Tear
- Pain: Pain in the shoulder, often worsening at night or with specific movements, such as lifting the arm or reaching behind the back.
- Weakness: Weakness in the shoulder, particularly when lifting or rotating the arm.
- Limited Range of Motion: Difficulty moving the arm through its full range of motion.
- Clicking or Popping: Some individuals may experience a clicking or popping sensation when moving the shoulder.
Diagnosis
Diagnosis typically involves a combination of physical examination, medical history, and imaging studies such as:
- X-rays: To rule out other causes of shoulder pain.
- Magnetic Resonance Imaging (MRI): To assess the extent of the tear and the condition of the tendons and surrounding structures.
- Ultrasound: Can also be used to visualize the rotator cuff and detect tears.
Treatment Options
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Conservative Management:
- Rest and activity modification.
- Physical therapy to strengthen the surrounding muscles and improve range of motion.
- Anti-inflammatory medications or corticosteroid injections to reduce pain and inflammation.
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Surgical Repair:
- Arthroscopic Surgery: Minimally invasive surgery where the torn tendon is reattached to the bone using small incisions.
- Open Surgery: A more traditional approach that may be necessary for large or complex tears.
- Tendon Transfer or Shoulder Replacement: In cases where the tear is too severe to repair, other surgical options may be considered.
Recovery and Rehabilitation
Recovery can take several months, especially if surgery is required. Rehabilitation typically involves a structured physical therapy program designed to restore strength, flexibility, and function to the shoulder.
Author
Dr. Catherine Logan, MD, MBA
Catherine Logan, MD, MBA, MSPT, is a sports medicine orthopaedic surgeon specializing in complex knee and shoulder surgery at Colorado Sports Medicine and Orthopaedics (COSMO) in Denver, Colorado. As a former physical therapist & trainer, Dr. Logan provides a distinct expertise in sports injury, prevention, and surgical management.
