Stop Shoulder Pain: Rotator Cuff Tear Explained

23 May,2024

Are you a painter, athlete, weightlifter, or someone who has physically demanding hobbies like gardening? Then, you might be at a risk of having rotator cuff injuries, mostly a tear. Wondering why? The repetitive stress can irritate or tear the tendons, causing shoulder pain that can significantly limit your ability to move your arm.

The good news is that most rotator cuff injuries respond well to conservative treatment, which involves a combination of rest, ice therapy, anti-inflammatory medications, and physical therapy. However, depending on the severity of the tear, surgery might be necessary in some cases. With advancements in surgical techniques, surgery for rotator cuff tears is done arthroscopically, which is a minimally invasive approach.

Don't hesitate to visit an orthopedic hospital if you're experiencing shoulder pain, especially with overhead activities. Early intervention can help ensure a quicker and more complete recovery, keeping you in motion and doing what you love. 

Read further to better understand rotator cuff tears, their symptoms, and available treatment options.

What is a Rotator Cuff Tear?

The rotator cuff isn't a single muscle but a team effort! It's a group of four muscles and their tendons that work together to provide stability and mobility to your shoulder joint. These muscles begin from your shoulder blade and wrap around the head of your humerus (upper arm bone), forming a "cuff" that holds the arm in the socket. Their coordinated action allows you to raise your arm overhead, rotate it inwards and outwards, and reach behind your back – all essential movements for everyday activities.

A rotator cuff tear is a type of shoulder injury that causes pain and instability in the arm. The two most common types of rotator cuff tears are partial and complete. The tendon doesn't completely detach from the bone in a partial rotator cuff tear. In a full-thickness or complete rotator cuff tear, the tendon gets wholly separated from the bone.

Depending on the size, rotator cuff tears can be classified as – 

• Small Tear: A tear that is less than 1 cm in size
• Medium Tear: Tears ranging from 1 to 3 cm
• Large Tear: Tear in the range of 3 to 5 cm
• Massive Tear: A tear that is over 5 cm in size

What are the Signs of a Rotator Cuff Tear?

Intense pain is the first and most common sign of a rotator cuff tear. The severity of the tear can affect shoulder pain. It often starts as a dull ache, especially at night, and worsens with activities that involve raising the arm.

A limited range of motion, reduced functionality, and weakness in the shoulder are also common. Other symptoms of rotator cuff tear are- 

• Disturbed sleep
• Difficulty combing hair or reaching behind your back
• Crepitus (a popping, crackling, or clicking sensation)
• Shoulder stiffness
• Difficulty reaching out to the side
• Pain while sleeping on the affected shoulder

Not every rotator cuff tear is painful. However, if you are experiencing weakness and difficulty raising your arm, especially after an injury, you must consult an orthopedic doctor immediately. Timely diagnosis and treatment are paramount for preventing further damage and ensuring a full recovery. If rotator cuff tears are left untreated, they can lead to more severe problems over time, such as a frozen shoulder or arthritis.

What are the Causes and Risk Factors of Rotator Cuff Tear?

A rotator cuff tear is either due to acute injury or degenerative. Young people are more prone to acute injuries that mainly occur from one particular incident. Lifting heavy objects, explicitly moving the shoulder in a specific position, and falling are common causes of acute injuries.

Degenerative tears occur over a period of time due to the wearing down of the tendons. Common reasons for degenerative or chronic rotator cuff tears are – 

• Repetitive Stress: Repeated shoulder motions cause stress on the shoulder, especially on the rotator cuff muscles and tendons. Baseball, weightlifting, tennis, and river rafting can lead to overuse tears. 
• Bone Spurs: Bony growth or spurs form over the shoulder bone. These spurs rub against rotator cuff tendons when you lift the arm, creating a fiction. Shoulder impingement between the bone and tendon can lead to a partial or complete tear.
• Decreased Blood Supply: Blood flow to the rotator cuff muscles and tendons decreases as you age. Without a healthy blood supply, these muscles are unable to repair themselves. It ultimately leads to a rotator cuff tear.

Risk Factors of Rotator Cuff Tears

Over 2 million Americans suffer from rotator cuff problems each year. Apart from the two primary causes, several risk factors have been linked to rotator cuff tears. These include – 

• Age: The risk of tearing the rotator cuff increases with age. Shoulder tears are more common in people over 60.
• Family History: Rotator cuff injuries can also be linked with family history, as these tears are more common in certain families.
• Occupation: Jobs such as gardening, carpentry, construction work, or house painting require repetitive overhead arm motions and can cause damage to the rotator cuff over time.
• Sports: People who participate in particular sports, such as rowing, baseball, tennis, and weightlifting, are more prone to certain types of rotator cuff injuries.

How is a Rotator Cuff Tear Diagnosed?

Orthopedic doctors consider multiple factors when diagnosing rotator cuff tears. They will perform a thorough and detailed physical examination to assess your shoulder's range of motion, strength, and tenderness.

The final diagnosis will be made after running imaging tests such as –

• X-ray: Although X-rays cannot help view soft tissues, orthopedic doctors use this imaging technique to exclude other potential reasons for shoulder pain, such as sclerosis and arthritis.
• MRI: Magnetic resonance imaging (MRI) can help diagnose rotator cuff tears by producing clear images of the muscles and tendons. MRI machines make these images by using strong magnetic fields and radio waves.
• IMPT (Isokinetic Muscle Performance Test): It helps establish the strength of shoulder muscles.
• Ultrasound: During ultrasound, the soft tissues of the shoulder are viewed on a monitor. The technology uses sound waves to make images of the muscles and tendons of the shoulder. Doctors can also use ultrasound to compare the affected shoulder with the healthy one.

What Treatment Options Are Available for a Rotator Cuff Tear?

The treatment of a rotator cuff tear depends on factors such as age, type & degree of injury, general health, activity level, and extent of pain. Doctors mostly recommend nonsurgical management for rotator cuff injuries. However, surgical interventions are necessary in some instances. Various treatment methods available for rotator cuff tears are mentioned below.

Nonsurgical Treatment

Over 80% of patients experience significant improvement in pain and function of the shoulder with nonsurgical treatments. It is the first line of treatment for rotator cuff injuries and can include –

• Rest and Arm Slings: Patients with rotator cuff injuries are advised to wear arm slings to minimize shoulder use. This gives them the necessary time for the pain to subside.
• NSAIDs: Nonsteroidal anti-inflammatory medications such as ibuprofen, aspirin, and naproxen help minimize pain and swelling associated with rotator cuff tears. 
• Physical Therapy: Specific exercises and physical therapy will help restore movement and strengthen your shoulder muscles. The exercise program will include stretches to improve joint flexibility and range of motion. Strengthening the shoulder muscles helps alleviate pain and prevent further injury.
• Steroids: Cortisone injections are recommended if the rotator cuff tear is causing significant pain that is not reduced with medications, rest, and physical therapy. It is a very effective anti-inflammatory drug. However, prolonged use can weaken the tendons, ultimately doing more harm than good.

Eight out of 10 patients with partial rotator cuff tears get the desired treatment outcomes with nonsurgical methods. However, this treatment method has a few disadvantages, such as a limit to specific activities and the possibility that the tear size will increase with time. 

Note: Rotator cuff tears do not heal on their own. 

Surgical Treatment

Not every patient with rotator cuff injuries or tears requires surgery. The doctor recommends surgical interventions for patients who have – 

• Active lifestyle and regularly require overhead movement of the arm
• Symptoms that have not resolved since 6 to 12 months
• Continuous excruciating pain 
• Significant weakness and loss of joint function
• A tear more than 3 cm in size

The most common surgeries done for rotator cuff tear are – 

• Traditional Open Repair: The open repair technique was the first surgical intervention for large tears requiring tendon transfers. The surgeon makes an incision over the shoulder and splits part of the shoulder muscles (deltoid). This helps them better visualize and access the torn tendon. During an open repair, the surgeon typically removes bone spurs. This procedure is called an acromioplasty. With time, several new techniques have been developed to avoid large incisions. 
• Arthroscopic Repair: In an arthroscopic repair, the surgeon makes a tiny incision and inserts mini surgical tools and an arthroscope. The arthroscope lets the surgeon view the shoulder structures live on a computer screen and perform the repair using the tools inserted. It is the least invasive procedure for rotator cuff tears and can be performed on an outpatient basis.
• Mini-open Repair: This technique combines arthroscopic and open repair techniques. The incision size is about 4-6 cm. The surgeon first visualizes the tendons using an arthroscope. Then, they insert larger instruments without detaching the deltoid muscles.

The Bottom Line

Don't let shoulder pain sideline you from the activities you love! Knowing the signs of a rotator cuff tear empowers you to take charge of your shoulder health. Contact a skilled orthopedic doctor for a proper diagnosis if you're experiencing shoulder pain, especially with overhead activities. Early intervention through non-surgical treatments like physical therapy can significantly improve your condition and get you back to moving freely.