Rotator Cuff Tear

Rotator cuff strains or tears are generally caused by:

• overuse
• wear and tear over time
• acute injury

Rotator cuff injuries can range from mild to severe. They tend to fall into one of two categories: acute or chronic. Tendinitis (acute) or tendinopathy (chronic) is typically caused by overuse of the rotator cuff muscle. This causes it to become irritated. The tendons that connect muscles to bones can overstretch (strain) or tear, partially or completely.

Tennis players who use an overhead serve and painters who have to reach upward to do their jobs commonly experience this injury. The rotator cuff can also be strained or tear after a fall, a car accident, or another sudden injury. These injuries typically cause intense and immediate pain.

Not all rotator cuff injuries cause immediate pain. Some are the result of degenerative conditions, meaning the rotator cuff could be damaged for months or years before symptoms start to appear.

Common rotator cuff injury symptoms include:

• significant pain that causes you to avoid certain activities
• pain or tenderness when reaching overhead
• trouble reaching behind the back
• difficulty reaching out to the side
• progressive weakness of the shoulder
• pain in the shoulder, especially at night
• difficulty sleeping on the affected shoulder

If you’ve been experiencing any of these symptoms for longer than a week or lose function in your arm, see your doctor. While these are symptoms of a rotator injury, they could be caused by something else.

Rotator cuff injuries can be acute or degenerative.

Acute injuries usually occur from one particular incident. These can be caused by lifting objects that are too heavy, falling, or having the shoulder forced into an awkward position. Young people are more likely to experience this type of rotator cuff injury.

Degenerative injuries are due to long-term overuse. People most at risk for these injuries include:

• athletes, particularly tennis players, baseball players, rowers, and wrestlers
• people with jobs that require repetitive lifting, like painters and carpenters
• people above 40 years of age

To diagnose a rotator cuff injury, your doctor may:

• take down your medical history
• perform a physical exam
• run imaging scans

Your doctor may ask about physical activities at the workplace. These questions determine whether you have an increased risk for a degenerative condition.

Your doctor will test your range of motion and strength. They’ll also rule out similar conditions, like a pinched nerve or arthritis.

Imaging scans, like an X-ray, can identify any bone spurs. These small bone growths can rub against the rotator cuff tendon and cause pain and inflammation.

MRI or ultrasound scans can also be used. These tools examine soft tissues, including the tendons and muscles. They can help identify tears and show how large and severe the tears have become.

Treatments range from resting the affected arm to surgery. Tendinitis can progress to a rotator cuff tear, and that injury can get worse with time. Seeking treatment as quickly as possible helps to keep the injury from progressing.

Nonsurgical treatments improve symptoms in about 80 percent of people with a rotator cuff injury. These kinds of treatments include:

• applying hot or cold packs to the affected shoulder to reduce swelling
• exercises to restore strength and range of motion
• physical therapy
• injecting the affected area with cortisone, a steroid that helps to reduce inflammation
• resting the affected arm and wearing a sling to isolate arm motions
• over-the-counter (OTC) anti-inflammatory medications, like ibuprofen and naproxen

According to the American Academy of Orthopaedic Surgeons, there’s no evidence that the timing of surgery affects outcomes. This means if you have a rotator cuff injury, your doctor is likely to first try nonsurgical methods.

The most common complication is re-tearing the rotator cuff after it’s healed. The larger the original tear, the higher the risk of a re-tear.

If the injury requires surgical repair, the risk of postoperative complications is small. General surgical risks include blood loss or issues with anesthesia. Complications related to the procedure itself include:

• frozen shoulder
• loss of motion
• permanent stiffness
• reduced cuff strength

Work with your doctor to take steps to minimize these risks.

Athletes and people with occupations that require using the shoulder should take frequent rest breaks. This can reduce the load on the shoulder.

Exercises to strengthen the shoulder and encourage range of motion also can help. Ask your physical therapist for stretches and strengthening exercises to improve the function of your rotator cuff.

In the case of shoulder pain, icing the affected area can help reduce swelling. Apply ice in a cloth-covered pack for no more than 10 minutes at a time.

Shoulder pain is common. If you’re experiencing pain for an obvious reason, like after overexertion, give yourself time to rest and recover.

If you’re experiencing more serious pain that doesn’t improve with rest, ice, and OTC pain relievers, it may be time to call your doctor. If pain worsens, inhibits your range of motion, or interferes with your normal day-to-day activities (including sleep), be sure to call your doctor.

If you get injured and feel a pop or tearing sensation in your shoulder and you can’t lift your arm, seek immediate medical attention.

The prognosis for a rotator cuff injury depends upon the injury type. Nonsurgical treatment improves the shoulder’s function and relieves pain in the majority of cases.

In the case of a more severe rotator cuff tear, shoulder strength may not improve unless the injury is surgically corrected.