Rotator Cuff Tears

by Mr. David Shields

Our shoulders are complex joints that allow us to move our arms in many different directions. This intricate structure is made up of bones, muscles, tendons, and ligaments all working together. One of the key components of the shoulder is the rotator cuff, a group of four muscles that surround the shoulder joint. These muscles and their tendons help stabilise the shoulder, rotate and lift the arm, and allow for a wide range of motion. When one or more of these tendons is torn , it is called a rotator cuff tear.

A rotator cuff tear occurs when one or more of the tendons of the rotator cuff muscles is torn. This can happen partially or completely, detaching the tendon from the bone. Most tears occur in the supraspinatus tendon, but other parts of the rotator cuff may also be involved.

There are a few different types of tears:

  • Partial tear: The tendon is not completely detached from the bone.
  • Full-thickness tear: The tendon is completely or partially detached from the bone.
    • Full-thickness incomplete tear: Only a small part of the tendon is detached from the bone.
  • Full-thickness complete tear: The tendon is completely detached from the bone, creating a hole in the tendon.
Can a Rotator Cuff Tear Heal?
Whether a rotator cuff tear can heal on its own depends on several factors, including the size and type of tear.
  • Partial tears: Non-surgical treatments, like rest, medication, and physiotherapy, are frequently effective in relieving pain and improving shoulder function for partial tears. This suggests that the body may be able to repair the damage to some extent.
  • Full-thickness tears: Surgical repair is often recommended to reattach the tendon to the bone for full-thickness tears, where the tendon is completely detached. This indicates that the body may not be able to bridge a complete tear without intervention.
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Regardless of the type of tear, early diagnosis and treatment are crucial for a better outcome. It’s essential to consult a doctor for proper diagnosis and a personalised treatment plan.

What causes a rotator cuff tear?

Rotator cuff tears can occur due to two main reasons: injury and degeneration.

  • Acute Tear (Injury): This type of tear happens suddenly, often due to a fall on an outstretched hand, a direct blow to the shoulder, or lifting something heavy with a jerking motion. These tears may occur in conjunction with other injuries, like a broken collarbone or a dislocated shoulder.
  • Degenerative Tear (Wear and Tear): Most rotator cuff tears develop gradually over time due to the wear and tear
    of the tendons. This degeneration is a natural process associated with aging.

Several factors can contribute to >degenerative rotator cuff tears:

  • Repetitive Stress: Repeating the same shoulder movements, especially overhead motions, can stress the rotator
    cuff muscles and tendons, making them more susceptible to tearing. Activities such as baseball, tennis, rowing, weightlifting, painting, and carpentry can increase the risk of overuse tears.
  • Lack of Blood Supply: As we get older, the blood supply to the rotator cuff tendons decreases. This reduced
    blood flow can hinder the body’s ability to repair tendon damage, increasing the likelihood of a tear. Other factors such as obesity, high cholesterol, diabetes and smoking have been implicated and are thought to reduce blood supply as well as prevent normal healing.
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Who is at risk of a rotator cuff tear?

While anyone can experience a rotator cuff tear, certain factors increase the risk:

  • Age: People over 40 are more susceptible to rotator cuff tears due to the natural wear and tear of tendons with age.
  • Repetitive Overhead Activities: Individuals engaging in jobs or sports that involve repeated overhead arm movements have an elevated risk of rotator cuff tears. This includes athletes, particularly tennis players and baseball pitchers, as well as people in professions like painting and carpentry.
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What are the symptoms of a rotator cuff tear?

Rotator cuff tears can present with various symptoms, which can differ in intensity depending on the severity of the tear:

  • Pain: This is the most common symptom and can be felt at rest, during activity, and at night, especially when lying on the affected shoulder. Pain may worsen when lifting and lowering the arm or with specific movements.
  • Weakness: Difficulty lifting or rotating the arm is another common symptom.
  • Crepitus: A crackling sensation or sound may occur when moving the shoulder in certain positions.
  • A Limited Range of Motion: The affected shoulder may have a reduced range of movement.
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Acute tears, like those caused by a fall, typically cause intense pain, a snapping sensation, and immediate weakness in the arm. Tears that develop
gradually may cause mild pain that worsens over time, potentially making everyday activities challenging. The pain might radiate down the arm, increase at night, or make it difficult to sleep on the affected side.

It’s important to note that some rotator cuff tears may not cause pain. However, even painless tears can lead to weakness and other symptoms, impacting shoulder function. Any unusual shoulder pain or weakness should be evaluated by a doctor.

How is a rotator cuff tear diagnosed?

Diagnosing a rotator cuff tear involves a combination of:

  • Medical History: Your doctor will discuss your symptoms, their duration, and any activities or injuries that may have contributed to the problem.
  • Physical Examination: Your doctor will examine your shoulder, checking for tenderness, deformities, and
    range of motion. They will assess your arm strength and may also examine your neck to rule out other
    conditions, such as a pinched nerve or arthritis.
  • Imaging Tests: These tests can help confirm the diagnosis and provide detailed information about the tear.
    • X-rays: X-rays are usually the first imaging test done to rule out other causes of shoulder pain, such as arthritis. They may show bone spurs, which are bony growths that can develop on the bones of the shoulder, but they don’t show the soft tissues like the rotator cuff tendons.
    • Magnetic Resonance Imaging (MRI) or Ultrasound: MRI and ultrasound can visualise the soft tissues of
      the shoulder, including the rotator cuff tendons. These tests can show the location, size, and severity of the
      tear. An MRI can also provide information about the age of the tear and the quality of the surrounding
      muscles.
How is a rotator cuff tear treated?

Treatment for a rotator cuff tear aims to reduce pain, restore shoulder function, and improve quality of life. The best treatment approach depends on several factors, such as the type of tear, severity, your age, activity level, and overall health.

Non-Surgical Treatment:

In many cases, rotator cuff tears can be effectively managed without surgery. Non-surgical options focus on symptom relief and rehabilitation and may include:

  • Rest and Activity Modification: Avoiding activities that exacerbate pain is crucial for allowing the injured tissues to heal. Your doctor may recommend modifying your daily activities and avoiding movements that stress the shoulder.
  • Medications:
    • Pain Relievers: Over-the-counter pain medications, such as paracetamol or ibuprofen, can help manage pain and reduce inflammation.
    • Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Prescription NSAIDs may be recommended for more significant pain and inflammation.
  • Physical Therapy: This plays a vital role in rotator cuff tear rehabilitation. A physical therapist will guide you through exercises designed to:
    • Strengthen: Exercises target the muscles surrounding the shoulder to improve stability and support.
    • Improve Flexibility: Stretching exercises help restore range of motion and prevent stiffness.
  • Steroid Injections: Cortisone injections can be administered into the shoulder joint to reduce pain and inflammation. While effective for some, the duration of pain relief can vary.
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Surgical Treatment:

Surgery is typically considered when:

  • Non-surgical treatments haven’t provided sufficient relief after 6 to 12 months.
  • The tear is large (more than 3 cm) and the surrounding tissues
  • Significant weakness and loss of function are present.
  • Sudden deterioration if symptoms.
  • The tear was caused by a recent, acute injury.
  • You are very active or need full shoulder function for overhead work or sports.

Surgical repair usually involves re-attaching the torn tendon to the humerus (upper arm bone). Different surgical techniques can be used, and your orthopaedic surgeon will discuss the best option for your individual needs. Surgery can be performed arthroscopically (using small incisions and a camera) or through a traditional open incision. Rehabilitation after surgery is essential and involves physical therapy to regain strength, flexibility, and range of motion.

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FAQs About Rotator Cuff Tears
How long does a rotator cuff tear take to heal?

Healing time for a rotator cuff tear varies depending on factors such as the tear’s severity, the treatment approach (surgical or non-surgical), individual healing capacity, and adherence to rehabilitation. Generally:

  • Non-surgical treatment: It can take several weeks to months for symptoms to improve and for the shoulder to regain strength and mobility. Full recovery might take 4 to 6 months.
  • Surgical treatment: Healing after surgery also takes several months. It’s important to protect the repaired tissues while gradually increasing activity and range of motion as guided by your surgeon and physical therapist. Full recovery might take 6 to 12 months.
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What does a rotator cuff tear feel like?

The sensation of a rotator cuff tear can differ depending on the type and severity. Some people experience:

  • Sudden, sharp pain at the time of injury (especially with acute tears).
  • A dull ache deep in the shoulder.
  • Pain that worsens at night or when lying on the affected shoulder.
  • Pain that increases with arm movement, especially overhead activities.
  • Weakness when lifting or rotating the arm.
  • A clicking or popping sensation when moving the shoulder. Some rotator cuff tears, especially those that develop gradually, may not cause noticeable pain.
Can you still lift your arm with a torn rotator cuff?

The ability to lift your arm with a torn rotator cuff depends on the severity of the tear. You may experience:

  • Partial tear: You might experience pain and weakness when lifting your arm, but you might still be able to lift it to some extent.
  • Full-thickness tear: Lifting your arm, especially above shoulder height, might be significantly difficult or impossible due to pain and weakness.

If you suspect a rotator cuff tear, it’s best to see a doctor for proper diagnosis and treatment recommendations.

What happens if you don’t fix a rotator cuff tear?

Ignoring a rotator cuff tear can potentially lead to:

  • Worsening pain and weakness: As the tear progresses, the pain and weakness in the shoulder can increase, making it more difficult to perform everyday activities.
  • Stiffness and limited range of motion: The shoulder joint can become stiff and lose its range of motion if the tear is not addressed.
  • Muscle atrophy: The muscles surrounding the shoulder can weaken and waste due to lack of use and instability.
  • Development of arthritis: Untreated rotator cuff tears can increase the risk of developing shoulder arthritis.

Early diagnosis and treatment are important for preventing these complications.