What Is a Rotator Cuff Tear?

A rotator cuff tear is a common injury, especially in sports like baseball or tennis, or in jobs like painting or cleaning windows. It usually happens over time from normal wear and tear, or if you repeat the same arm motion over and over. But it also can happen suddenly if you fall on your arm or lift something heavy.

Your rotator cuff is a group of four muscles and tendons that stabilize your shoulder joint and let you lift and rotate your arms.

There are two kinds of rotator cuff tears. A partial tear is when the tendon that protects the top of your shoulder is frayed or damaged. The other is a complete tear. That’s one that goes all the way through the tendon or pulls the tendon off the bone.

Symptoms

You can’t always feel a torn rotator cuff. But in some cases, you might:

  • Have trouble raising your arm
  • Feel pain when you move your arm in certain ways or lie on it
  • Have weakness in your shoulder
  • Be unable to lift things like you normally do
  • Hear clicking or popping when you move your arm

See your doctor if you have any of these signs. If you don’t do anything about a torn rotator cuff, you can have more serious problems over time. You can end up with a frozen shoulder or arthritis that is harder to treat.

Diagnosis

To find out if you have a torn rotator cuff, your doctor will start with a history of the injury and a physical examination of the shoulder. During the exam, he’ll check your range of motion and muscle strength. He’ll also see what movements make your shoulder hurt.

In addition, your doctor may use one of the following:

  • MRI. This uses radio waves and a powerful magnet to make detailed pictures of your shoulder.
  • X-rays to see if the top of your arm bone (humeral head) is pushing into your rotator cuff space.
  • Ultrasound to see the soft tissues (tendons and muscles and the bursas) in your shoulder.

Continued

Treatment

Your doctor is likely to start with a combination of physical therapy to make your shoulder muscles stronger, and medications like acetaminophen and anti-inflammatory drugs to help with pain and swelling. Surgery may be required in some cases.

You also may get exercises to do at home and suggestions that help you use your shoulder in safer, more comfortable ways in your day-to-day life.

If those don’t work, you may need surgery, especially if you have a complete tear. It’s likely your doctor will need to stitch together the torn area or reattach the tendon to the bone.

In some cases, he might need to take out small pieces of tendon or bone that are stuck in your shoulder joint or remove small areas of bone or tissue to give your tendon more room to move.

There are three types of rotator cuff surgery:

  • Arthroscopic: Your doctor will make a small cut in your shoulder then use an arthroscope -- a tube with a small camera and tiny instruments -- to fix the tear. This means your recovery time will likely be shorter than it would with another type of surgery.
  • Open: Your doctor uses larger instruments to go in to the muscles of your shoulder and fix the tear.
  • Mini-Open: This uses both arthroscopic and open methods. Your doctor starts with the arthroscope and finishes with larger instruments.

Recovery

After surgery, you’ll wear a sling for 4 to 6 weeks. Your doctor probably will tell you to do the following to speed along your recovery:

  • Take the sling off several times a day and move your elbow, wrist, and hand to get better blood flow in those areas.
  • If you have pain and swelling in your shoulder, use an ice pack for about 20 minutes at a time.
  • Most important: Do not lift your arm at the shoulder until your doctor says it’s OK.

How your recovery goes will depend a lot on the size of the tear and how long your rotator cuff was torn. The smaller and more recent the tear, the better your chances of being pain-free and having a full range of motion.

Be patient. Recovery is a gradual process. It can take up to a year for you to have full use of your shoulder again.

WebMD Medical Reference Reviewed by Sabrina Felson, MD on 7/, 017

Sources

SOURCES:

Alberta Evidence-based Practice Center: “Comparative Effectiveness of Nonoperative and Operative Treatments for Rotator Cuff Tears.”

Massachusetts General Hospital, Orthopaedics, Sports Medicine: “Shoulder -- Torn Rotator Cuff.”

American Society for Surgery of the Hand: “Rotator Cuff Injuries.”

OrthoInfo: “Rotator Cuff Tears.”

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