What is a Rotator Cuff Tear?
A rotator cuff tear is a tearing of one or more of the four muscle tendon units that are responsible for moving and powering the shoulder joint. The shoulder joint has the greatest degree of mobility compared to all other joints of the body. Rotator cuff tears are commonly seen in athletes who have participated in overhead sports, such as swimming, tennis, baseball, and volleyball. It can also occur with those who have jobs involving overhead lifting, such as carpenters and house painting.
Rotator cuff tears occur in almost 2 million patients every year. In a complete or “full thickness” rotator cuff tear, one of the rotator cuff tendons has completely detached from its attachment on the top of the arm bone (humerus). Patients with rotator cuff tears experience weakness in the shoulder, along with pain in the shoulder and upper arm. Daily activities requiring lifting become challenging due to pain and weakness. Dr. Cunningham is a shoulder specialist at Vail Summit Orthopaedics. He is an expert at diagnosing and treating rotator cuff tears for patients in Vail, Summit County, Aspen, and Denver, CO.
How Does a Torn Rotator Cuff Occur?
The shoulder joint is the most mobile joint of the body. As such, it sustains a constant and stressful workload. Over time, “wear and tear” changes in the rotator cuff tendons occur. Dr. Cunningham likens these changes to the fraying of a rope. The rope or tendon slowly frays until it completely tears. A fall or sudden injury such as a shoulder dislocation may tear an otherwise intact tendon away from the bone or a tendon may slowly lift and detach from the bone as we age and as it continues to be subjected to increased stresses at the tendon attachment site.
Some elements contributing to chronic rotator cuff tears are:
- Diminished blood flow to tendons, common with aging
- The presence of bone spurs impinging the tendon
- Repetitive overhead work and overhead sports
What is the Difference Between a Partial and Full-Thickness Tear?
A partial thickness tear is partial detachment of the rotator cuff tendon from its attachment to the humerus. A typical rotator cuff inserts over a half inch area on the humerus bone. If 50% of the tendon is torn, then the tendon is only attached over a quarter inch area of the bone. In a full-thickness rotator cuff tear, a rotator cuff tendon has completely detached from its normal bony attachment site. When a rotator cuff tendon has completely detached, then this muscle can no longer exert a force on the bone, thus a patient feels weaker.
What Does a Torn Rotator Cuff Feel Like?
Typical symptoms associated with a torn rotator cuff include:
- Pain down the side of the arm
- Pain that wakes you at night
- Weakness when trying to lift something overhead or behind
- Worse pain in the shoulder with reaching overhead or behind
- Persistent deep dull ache
- Cracking and popping in the shoulder when moving the shoulder
A rotator cuff tear due to trauma often causes immediate intense pain. There may be an accompanying popping sensation and sudden loss of strength in the upper arm. By comparison, tears that develop slowly over time may have subtle symptoms at first, such as mild discomfort with reaching movement. Steadily over time though the pain weakness worsens. Activities of daily living, such as lifting something off of a high shelf, may become harder to do. Pain at night that interrupts sleep is common and often what brings patients into Dr. Cunningham’s office for evaluation. It is important to note that in some cases a rotator cuff tear does not cause severe pain. However, a noticeable loss of strength may indicate a tear.
How is a Rotator Cuff Tear Diagnosed?
If you sustain a trauma resulting in immediate pain and/or weakness of the shoulder and arm, then it is advisable to seek orthopedic evaluation. An orthopedic shoulder specialist will obtain a history detailing when and how your symptoms started. A thorough physical exam of the shoulder is performed. Shoulder range of motion is checked followed by a detailed strength exam evaluating the strength in each of the four rotator cuff muscles. There are several specific tests that further suggest a rotator cuff tear.
Diagnostic imaging is helpful to confirm the diagnosis. X-rays will show if there is any arthritis in the shoulder, calcific deposits where the rotator cuff tendons attach, or whether there are bone spurs that could predispose one to tear their rotator cuff tendons. A magnetic resonance imaging (MRI) of the shoulder may be ordered as this will clearly show if a rotator cuff tendon is partially or completely torn. An MRI shows which tendons are torn and whether any of these torn tendons have started to retract from their normal attachment site on the top of the humerus. An MRI will also show if there is atrophy of the rotator cuff muscles, which can be seen in the setting of a chronic tear.
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Does a Rotator Cuff Tear Require Surgery?
Inflamed rotator cuff tendons or smaller, partial rotator cuff tears may recover with non-surgical treatments. These treatments include resting the shoulder, ice therapy, and physical therapy. In some cases, steroid injections or platelet rich plasma (PRP) injections can also help reduce inflammation and pain.
Most full thickness rotator cuff tears in otherwise healthy people are better treated with surgery as these tears will not heal and will only get larger, more retracted, and worsen over time. If one waits too long, a torn rotator cuff tendon may be so far retracted from its normal attachment site on the bone, that it can no longer be surgically repaired, and then other salvage type surgical options may be required. There are several surgical treatment options, depending on the condition and expected outcome for the individual patient. These include:
- Arthroscopic tendon repair: Most patients are treated with an arthroscopic rotator cuff tendon repair. In this treatment, minimally invasive tools and techniques are utilized to reattach a torn tendon to its normal attachement on the top of the humerus bone. Recovery time is quicker compared to open procedures.
- Superior Capsular Reconstruction: For patients with massive, retracted rotator cuff tears where the tendon can no longer be stretched back over to its normal attachment site, a donor tendon may be arthroscopically implanted in its place. This is a fairly new procedure that Dr. Cunningham has been doing for these more difficult types of tears.
- Shoulder replacement: For patients with large, severely retracted rotator cuff tendon tears that are no longer repairable and when there is also arthritis in the shoulder, then a special type of shoulder replacement called a reverse total shoulder arthroplasty would be considered. This surgery is typically done in older individuals and they can do well with elimination of most pain and a return to reasonable shoulder function.
Dr. Cunningham is a shoulder specialist at Vail Summit Orthopaedics. He is an expert at diagnosing and treating rotator cuff tears for patients in Vail, Summit County, Aspen, and Denver, CO. Contact Dr. Cunningham today.
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Dr. Cunningham specializes in the treatment of knee, shoulder, and sports injuries.