ROTATOR CUFF TEARS

SHOULDER TOPICS

*These pages are for informational purposes only and are not intended as medical advice. Please consult a physician for specific diagnosis and treatment options*

The rotator cuff is comprised of four muscle/tendon groups that attach between the shoulder blade (scapula) and upper arm bone (humerus). These muscle/tendon groups come together at the humerus and create a hood or cap over this. When the rotator cuff muscles tighten or contract, they pull on the rotator cuff tendon allowing the shoulder to move or rotate upward, downward, outward or inward. That is why it is called the rotator cuff.

Rotator cuff tendonitis or even tears can result when impingement syndrome is present. With the worsening of impingement syndrome, the rotator cuff attachment at the humerus bone can wear away over time causing "partial thickness tears" or "full thickness tears". Partial thickness tears indicate that the rotator cuff is only partially torn. Rotator cuff tears can also result when people are involved in repetitive throwing or rotational sports activities such as baseball, swimming or racketball sports. Overtime, this can cause looseness in the shoulder joint that can eventually lead to rotator cuff tears. Full thickness tears indicate that the rotator cuff is torn completely away from the humerus bone. How rotator cuff tears are treated depends on a variety of factors including degree of the tear, severity of the symptoms, age and health of the patient, and determining how much functional ability is expected of the shoulder. Surgical repairs are usually suggested for people who have more demands on their shoulder in everyday living or in sports activities. For older people who may not require significant overhead lifting ability, repairing a rotator cuff tear may not be as important to them.

SYMPTOMS

People typically experience aching in the shoulder on the top, front or on the outer part of the upper arm. The pain typically gets worse if the person tries to raise their arm above their head or to the front of their body. They have pain at night and have difficulty sleeping. The person can feel weakness in the shoulder depending on the severity of the injury and if the patient has a full thickness rotator cuff tear, they may not be able to raise their arm at all.

TREATMENT

If the tear or rotator cuff tendonitis is related to impingement, the treatment course would include rest and anti-inflammatory medication to reduce the pain and inflammation. Physical therapy will frequently help to restore the tone of the rotator cuff muscles and will subsequently also help to reduce the inflammation. If this conservative treatment for impingement syndrome is not effective, surgical intervention is usually the next step. (Please check the impingement syndrome link for surgical treatment).

Tears in the rotator cuff usually occur at the humerus bone. Surgical treatment for this would include attaching the rotator cuff back to the humerus bone. Whether this is done arthroscopically or through a small open incision is dependent on the severity of the tear and the doctor's preference. The rotator cuff can be secured by suture or by a plastic or metal anchor.

Rehabilitation is an important part of the recovery. A physical therapy program will be set up for the person to help regain their tone and strength in their shoulder.