Rotator Cuff Tear

What Is a Rotator Cuff Tear?

A rotator cuff tear is a rip in the group of four muscles and tendons that stabilize your shoulder joint and let you lift and rotate your arms (your rotator cuff). It’s also called a complete tear or a full-thickness tear.

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

It’s 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.

Rotator Cuff Tear 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.

Rotator Cuff Tear Causes and Risk Factors

You can tear your rotator cuff in two ways: injuring your shoulder or wearing down your tendons over time.

A worn down rotator cuff that tears is called a degenerative tear. Your risk of this goes up with:

  • Occupation. Jobs like house painters and construction workers put you at a higher chance of rotator cuff tears.
  • Lack of blood supply. As you get older, you get less blood to your rotator cuff area, which makes small tears hard to repair, leading to larger tears.
  • Bone spurs. Bone overgrowth in the shoulder, which happens more often as you get older, can wear away the rotator cuff tissues and cause tears. 
  • Age. Rotator cuff tears are most common in people over 60.
  • Family history. Doctors think there could be a genetic piece to rotator cuff tears. They happen more often in certain families.
  • Athletics. Baseball, tennis, rowing, and weightlifting are sports that stress your rotator cuff and put you at risk of tears. 

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Rotator Cuff Tear 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, they’ll check your range of motion and muscle strength. They’ll also see what movements make your shoulder hurt.

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

  • MRI, which 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, muscles, and the bursas) in your shoulder.

Rotator Cuff Tear Complications

If you don’t treat your rotator cuff tear, you may experience weakness, or you could lose the ability to move your shoulder permanently. Your shoulder joint may deteriorate too. 

You’ll need to rest your shoulder as you recover, but if you keep it still for too long your connective tissue can thicken up and get tight. This is called frozen shoulder.

Rotator Cuff Tear Treatment

Your doctor is likely to start with a combination of several treatments including:

  • Physical therapy to make your shoulder muscles stronger
  • Medications like acetaminophen and anti-inflammatory drugs to help with pain and swelling
  • 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.
  • Rest to allow your rotator cuff to heal
  • Steroid injections into your shoulder joint, which can provide temporary pain relief

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, they 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.

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 into 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.
  • Tendon transfer. If your tendon is too torn to reattach, the doctors can use another nearby tendon.
  • Shoulder replacement. If the rotator cuff tear is large enough, you may need to have your shoulder joint replaced.

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Rotator Cuff Tear Outlook

After surgery, you’ll wear a sling for 4-6 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: Don’t 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.

Rotator Cuff Tear Prevention

To reduce your risk of a rotator cuff tear, especially if you’re in a high-risk category, you can do exercises to strengthen your shoulders. 

You should focus on both the front muscles of the chest, shoulder, and upper arm, as well as the back of your shoulder. This balances your muscles. Ask your doctor for exercise ideas to help strengthen your shoulder area.

WebMD Medical Reference Reviewed by Arefa Cassoobhoy, MD, MPH on August 11, 2020

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.”

HSS: “Rotator Cuff Tears, Injuries and Treatments.”

Mayo Clinic: “Rotator Cuff Injury.”

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