Rotator Cuff Tears

Rotator cuff tears affect three million people in the U.S. each year. This type of injury can cause nagging, aching shoulder pain that limits daily activities. While many people think of rotator cuff tears as only happening to professional athletes, this shoulder pain can happen to anyone. And if it does, even pulling a shirt over your head or raising your hand to comb your hair can be nearly impossible. Here’s how rotator cuff tears happen and what you need to know to treat them.

What is a rotator cuff tear?

Understanding the anatomy of the shoulder is helpful to see how a rotator cuff can get injured. The shoulder joint is a ball-and-socket joint that allows your arm to move around in circles, instead of just forward or backward.

At the back of the shoulder, the rotator cuff is made of four muscles that cover the head of your humerus bone (the upper arm bone). These muscles are attached to the humerus by tendons, with the whole structure connecting the humerus to the shoulder blade. Between these bones and the cuff is a lubricating sac called the acromion. The acromion prevents bone from rubbing on bone.

A rotator cuff tear occurs when one of the tendons is injured and no longer attaches properly to the top of the humerus bone. The most common rotator cuff tear is in the supraspinatus muscle and tendon. When the rotator cuff tears, this can cause an inflammation of the acromion, which may cause additional pain.

Types of rotator cuff tears

There are four classifications of rotator cuff tears, including:

Partial: Occurs when the tendon is damaged or overstretched but not completely severed
Full-thickness (or complete): The soft tissues are completely separated, with the tendons often detached from the humerus
Acute: This type of tear is a result of accident, trauma, or injury
Degenerative: Degenerative rotator cuff tears occur over time due to repetitive motions or because of other comorbidities (e.g., diabetes) that wear down the tendons of the dominant arm

What causes rotator cuff tears?

Many people think about professional pitchers in major league baseball when they think about rotator cuff tears, and it’s appropriate. Rotator cuff tears are the most common injury that sidelines pitchers at all levels of the game. Throwing the ball over and over again can wear away the tendons, causing a rotator cuff tear.

In the same way, the most common causes of a rotator cuff tear are overuse or injury. Maybe you lift a heavy box too quickly, or your job has you moving your arm overhead in a repetitive motion for hours a day.

Another cause of rotator cuff tears is age. A lack of blood supply to the area, a common feature of getting older, reduces the body’s natural ability to repair itself. If a tendon is already slightly injured and the blood supply is diminished, a tear can occur.

Most rotator cuff tears occur from a combination of repetitive and degenerative causes. People ages 40 and older are most at risk, as are those people with jobs or activities that feature repetitive shoulder motions, especially in their dominant arm.

Symptoms of rotator cuff injury can include some or all of the following:

Pain when lying on the shoulder at rest
Pain when lifting and lowering the arm
Weakness in the limb (especially when rotating the arm)
Crackling noise when moving the arm

When a tear occurs from a sudden injury, such as falling off a ladder or in a car accident, there may be a snapping noise, then intense pain and weakness in the arm.

How to diagnose rotator cuff injuries

Your doctor will conduct a complete physical exam that features palpation and movement through range of motion exercises. They will rule out arthritis and a pinched nerve during this examination. They’ll use range of motion exercises to move the arm in various directions to determine the source of the pain (and test for arm strength).

X-rays are unable to show soft tissue injuries, so an MRI and ultrasound will likely confirm the tear diagnosis. The MRI should show the size and location of the tear. Your doctor may also be able to determine how old the injury is.

Common rotator cuff treatments

The first treatment for a rotator cuff tear is complete rest. Tendon injuries take a long time to heal. Any aggravation can send them flaring up.

In addition to rest, there are other rotator cuff treatments your doctor will typically recommend first:

Avoid activities that cause pain
Ice inflamed shoulders (or use heating pads for muscle spasms)
Use non-steroidal anti-inflammatory over-the-counter medications (e.g. ibuprofen or Aleve)
Go to regular physical therapy
Get steroid injections into the shoulder

Half of all rotator cuff tear patients report pain relief without surgery. It’s important to note that the above treatment options (save physical therapy) do not improve the strength of the shoulder, they only minimize pain. In the case of a complete tear, a final treatment option—surgery—may be necessary to fully restore the shoulder to its full range of healthy motion.