Rotator Cuff Tears

Shoulder Specialists in Orange County

Rotator cuff tears are unfortunately common, with almost 2 million Americans seeking medical attention every year for this exact condition. Rotator cuff tears are most common in the person’s dominant arm. Be careful about continuing to use your rotator cuff if you’ve sustained an injury, as you could make your condition worse and increase the size of the tear over time.

Do I Have a Rotator Cuff Tear?

The condition is mainly characterized by a weakened, painful shoulder that makes daily life more difficult. Even doing something as simple as brushing your hair can cause severe pain.

Symptoms of a rotator cuff tear, no matter the initial cause (acute or chronic) include:

• Pain, even while at rest, especially when lying on the affected shoulder
• Discomfort with particular movements or when lifting and lowering the affected arm
• Weakness in rotating or lifting the arm
• Crackling sensations when moving the arms in specific directions

Chronic shoulder pain is a good reason to seek orthopedic treatment, as early treatment can prevent your symptoms from worsening, and it will get you back to your daily routine that much more quickly.

Anatomy of the Shoulder

To understand what a rotator cuff is, it helps to understand the anatomical structures of the shoulder. The ball-and-socket joint, the shoulder, is made up for 3 bones: the upper arm bone, the shoulder blade, and the collarbone. The arm is kept in this ball-and-socket joint by the rotator cuff, which is a group of 4 muscles coming together as tendons to cover the head of the humerus (the upper arm bone), and to help lift and rotate the arm. When the rotator cuff tendons are injured or damaged, it likely causes the lubricating sac called a bursa to limit the free gliding of the arm you are used to having.

When the rotator cuff becomes torn, the tendon is no longer attached to the humerus’ head. Most patients experience torn tendons that start as minor fraying, but the damage can progress and lead to complete rupture of the tendon, say, by lifting a heavy object. Incomplete tears damage the tendon without severing it, while a complete tear separates all of the tendon, basically causing a hole in it.

What Causes Rotator Cuff Tears?

There are several causes of rotator cuff tears. Acute tears, such as falling on an outstretched arm may cause other shoulder injuries at the same time, necessitating more complex treatment by a skilled orthopedic shoulder surgeon. Degenerative tears are more common than acute tears, as described above. Degenerative tears result from worn-down tendon tissue that occurs slowly over time, which occurs naturally in the aging process. Degenerative tears may be found in one or both shoulders, even if the patient experiences no pain in the “unaffected” shoulder.

Rotator cuff tears may be aggravated by:

• Repetitive movements: Athletes who play sports that can put them at risk for overuse tears include baseball, rowing, tennis, weightlifting, and more. Often, those in physically active job positions can also sustain overuse tears.
• Lack of blood supply: Older adults have less blood supply in their rotator cuff tendons. This impairs the body’s natural ability to heal itself in the event of tendon damage, which can ultimately lead to a tendon tear.
• Bone spurs: Bone overgrowth can develop and rub on the rotator cuff tendon, especially when lifting the arms. This condition is called shoulder impingement.

Diagnosing Rotator Cuff Tears

Your orthopedist will carefully examine your shoulder to check if it is tender or if you have any shoulder deformities. Your doctor will ask you to move your arm in different directions and test your arm strength to measure your range of motion and grip strength in the affected versus non-affected arm. Your orthopedist will also check for any other conditions mimicking a rotator cuff tear, such as a pinched nerve or arthritis.

Imaging tests may be useful to confirm your diagnosis, including:

• X-rays, which may show a small bone spur (note: X-rays do not show any of the internal soft structures, and these tests are mainly to rule out other conditions).
• Magnetic resonance imaging (MRI) or ultrasounds studies can better show these soft tissues, including the location and size of the tear. Your orthopedist will also get a better idea of how old or new your damage is by viewing MRI images.

Rotator Cuff Treatments

It is important to seek treatment early since nonsurgical treatments can be very effective in relieving pain and improving range of motion in the shoulder.

Nonsurgical Rotator Cuff Tear Treatments Include:

• Resting the shoulder
• Taking nonsteroidal anti-inflammatory medications
• Corticosteroid / Cortisone Injections
• Physical Therapy stretching and strengthening exercises
• Activity modification

Surgical Rotator Cuff Tear Treatment

If your shoulder pain doesn’t improve after 6-12 months of trying the nonsurgical treatments your shoulder surgeon may recommend shoulder surgery. There are several different types of surgery to repair a rotator cuff tear and your shoulder surgeon will recommend the best course of action for the patient depending on the severity of the tear, size, location, mobility, quantity of tendon tissue and bone.

Surgical Rotator Cuff Tear Treatments Include:

• Arthroscopic rotator cuff repair: Your shoulder surgeon will insert a tiny camera (arthroscope) and tools through small incisions to reattach the torn tendon to the bone.
• Open tendon repair: If the size of the tear is quite large, your shoulder surgeon may recommend an open tendon repair whereby a larger incision to reattach the damaged tendon to the bone is made.
• Tendon transfer: If the torn tendon is too damaged to reattach, your shoulder surgeon may decide to use a nearby tendon as a replacement and reattach it to the bone and remove the damaged tendon.
• Shoulder replacement: Severe rotator cuff injuries may require total shoulder replacement. To improve the artificial joint’s stability, a reverse total shoulder replacement procedure may be performed, whereby the socket and metal ball are switched. This allows the patient to use the deltoid muscle instead of the torn rotator cuff to elevate the arm.

Do you need treatment for a rotator cuff tear? Contact Hoag Orthopedic Institute at (949) 705-6493 to schedule an appointment with us.

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