Torn Rotator Cuff

What is a rotator cuff?
 

One of the most common causes of shoulder pain is the result of a torn rotator cuff.

The rotator cuff is made up of 4 muscles. Their tendons (def.) form a "cuff" of tissue over the upper end of the arm bone (humerus) — the rounded "ball" at the top of the ball and socket joint. The space between the rotator cuff and the shoulder blade (scapula (def.)) is cushioned and lubricated by bursae (def.).

The rotator cuff helps you move your arm in a circular fashion:

  • swimming
  • throwing a ball
  • lifting an item overhead
  • putting on a jacket

One of these muscles (called the supraspinatus) rests on top of your shoulder. Its tendon travels under the shoulder blade, on the outside of the shoulder — a position that makes it vulnerable to injury. The injury can lead to inflammation of the tendon (tendinitis) or the nearby bursae (bursitis).

Torn rotator cuffs also are associated with what is called shoulder impingement syndrome, a squeezing or pinching of the rotator cuff.

Sometimes a rotator cuff tears completely. In other cases, there is only a partial tear.

Video animation View an animation of a torn rotator cuff.

What causes a torn rotator cuff? Who's at risk?
 

As we age, the tissue quality of the tendons weakens, making them more likely to tear. That's why rotator cuff tears are seen in older patients.

Repeated lifting or sports activities that require overhead movements also can cause a torn rotator cuff. Rotator cuffs may also tear when you fall on an outstretched hand or collide hard with something.

Sometimes arthritis can be associated with a torn rotator cuff (rotator cuff arthropathy). This happens when a rotator cuff has been torn for a long time and the shoulder has not been working properly.

What are the symptoms of a torn rotator cuff?
 

Normally a person with a torn rotator cuff will feel pain over the top and outer side of the shoulder. The pain may radiate down your arm. This is more obvious when you raise or extend your arm, or when you lower your arm to the side after you have moved your shoulder backward and raised your arm.

Simple tasks like getting dressed can be painful. Sleeping may be difficult because the pain wakes you up at night. Your shoulder may also feel weak. Sometimes there is a "popping" sound when you move.

Sometimes the pain is sudden and severe, especially after an injury. Other times it may be mild and occur only when you do things like reach overhead.

How is a torn rotator cuff diagnosed and treated?
 

Your doctor will take a thorough medical history and examine your shoulder. Your doctor also may suggest an MRI (def.) to distinguish between a fully torn and a partially torn rotator cuff. Your doctor may recommend that you treat your torn rotator cuff with rest, heat, or cold to the affected area, and pain/anti-inflammatory medications.

Other treatment options may involve using a sling, to rest your shoulder. Your doctor and physical therapist may propose a plan of strengthening exercises to improve mobility, strength, and function. Your doctor may also suggest you consult an orthopaedic surgeon that specializes in shoulders for advice.

If you and your surgeon decide on surgery, your surgeon can advise you if the surgery can be done arthroscopically. This form of minimally invasive surgery allows your orthopaedic surgeon to see inside your shoulder and to carry out procedures through tiny incisions in your shoulder.

Doing rotator cuff repair arthroscopically means surgeons can make small "poke" holes through the muscle and work deep in the shoulder. As a result, patients have much less pain postsurgery and a faster recovery, experts point out.

If the rotator cuff tear has advanced to an arthritic condition (rotator cuff tear arthropathy), your surgeon may suggest shoulder replacement.

What can I expect long-term?
 

The success of rotator cuff treatment involves many factors including your compliance with any suggested physical therapy, your age, overall health, and the extent of your condition.