What Is Rotator Cuff Tear?

Rotator cuff tear explained by San Antonio, Austin, Houston, Dallas Texas top pain doctors

Rotator cuff injuries, including tears, are a common source of shoulder pain in adults. The shoulder joint is a ball and socket joint consisting of bones, muscles, tendons, and other tissues. The bones that make up the shoulder joint include the scapula, clavicle, and humerus. The shoulder joint is stabilized by the muscles of the rotator cuff, including the supraspinatus, infraspinatus, teres minor, and subscapularis. The rotator cuff attaches the humerus to the scapula and helps to lift and rotate the arm. Between the rotator cuff and the bones of the shoulder is a fluid-filled sac, known as a bursa sac. The bursa allows the rotator cuff to glide smoothly while the arm is moving.

When one of the tendons of the rotator cuff tears, it no longer attaches to the humeral head. Any of the rotator muscles and tendons can tear, but tears most commonly occur in the supraspinatus muscle and tendon. When the rotator cuff is injured, the bursa may become inflamed, creating an additional source of pain.

Symptoms of a rotator cuff tear can include:

  • Pain in the shoulder, even at rest
  • Pain when lying on the shoulder
  • Pain with shoulder movement, particularly when reaching behind the back or over the head
  • Decreased range of motion of the shoulder
  • Weakness of the affected arm
  • Popping or cracking with movement of the shoulder
  • Pain radiating down the affected arm

A history and physical examination will be performed on patients who present with symptoms of a rotator cuff tear. Questions relating to history of previous shoulder injuries, onset of current pain, and specific questions related to current pain will be asked. The physical examination will include palpation and inspection of the affected area, range of motion testing, muscle testing, reflex and sensation testing, as well as special orthopedic tests that test for rotator cuff injury. If a rotator cuff tear is suspected, additional testing, including magnetic resonance imaging (MRI), X-ray, or ultrasound, may be completed to determine the degree of the tear.

Causes Of Rotator Cuff Tear

There are two main causes of rotator cuff tears, including acute injury and degeneration. Acute tears can occur by falling on an outstretched arm or by heavy, awkward lifting. Acute tears of the rotator cuff can occur with other injuries of the shoulder such as a fractured clavicle. Patients who suffer an acute rotator cuff tear will often report sudden, intense pain in the shoulder. This pain may be accompanied by a snapping noise and immediate weakness of the affected arm.

Although many patients report an abrupt onset of symptoms, most rotator cuff tears happen gradually over time and are the result of degeneration. Degenerative tears occur as the tendon wears down, and commonly affect the dominant arm. Patients presenting with a degenerative tear will typically report pain that started off mild and progressively worsened.

Various factors contribute to degenerative rotator cuff tears, including repetitive stress, reduced blood supply, and the presence of bone spurs. Repetitive stress can overload the tendons of the rotator cuff. Athletes who engage in overhead sports such as baseball, tennis, volleyball, and racquetball are most at risk of developing an overuse rotator cuff tendon injury.

Reduced blood supply in the rotator cuff tendon that occurs with aging can impair the body’s natural healing ability. This can lead to a degenerative tendon tear. Lastly, the presence of bone spurs can result in impingement of the shoulder. Over time, this impingement will lead to weakening of the rotator cuff tendons, making them more susceptible to tears.

Anyone can be affected by a rotator cuff tear, but certain factors have been identified that increase the risk of suffering from a rotator cuff tear, including:

  • Increasing age
  • Being male
  • Previous shoulder injuries
  • Participating in overhead sports such as tennis and baseball
  • Having a job that involves a significant amount of overhead work (e.g. painter)

Treatments For Rotator Cuff Tear

There are various treatment options for rotator cuff tears, ranging from conservative treatment methods to more invasive options. For pain that is mild, conservative treatment methods including rest, ice, and exercises to stretch and strengthen the shoulder joint are recommended. In addition, over-the-counter pain relievers and non-steroidal anti-inflammatory medications may be utilized. Modifying activities to reduce overhead activity is also recommended to allow for healing to occur.

Steroid injections are recommended to patients who do not respond to conservative treatment methods, or for those who suffer from chronic, debilitating shoulder pain. However, the risk of future tendon rupture is increased with this treatment, so it is important to ensure that the benefits of this therapy outweigh the risks.

It is vital that patients allow rotator cuff tears to completely heal even when inflammation and pain have dissipated in order to help prevent serious complications. The healing process can take anywhere from several weeks to months to occur.

Surgical intervention may be recommended for patients with long-standing pain, large tears, significant shoulder weakness, or for those who suffer an acute tear.

Conclusion

Rotator cuff tears are a common cause of shoulder pain in adults. Symptoms of a rotator cuff tear can vary among patients but can include pain in the affected shoulder, restricted range of motion, arm weakness, radiating pain, as well as popping and cracking of the shoulder. While many patients report an acute onset of symptoms, most rotator cuff tears are the result of degeneration. Various treatments exist for the treatment of rotator cuff tears. It is recommended that patients discuss their symptoms and expectations with their doctors in order to determine what treatment options will offer the most effective relief for their case.

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