Rotator Cuff Tears

What is a Rotator Cuff Tear?

A rotator cuff tear is a common injury in which one or more of the four shoulder tendons that stabilize and move the shoulder joint detach from the bone. The injury is painful and often worsens at night, causing significant weakness when lifting or rotating the arm.

For most patients, a torn rotator cuff typically begins as minor fraying, but the damage can progress and lead to a partial or complete rupture of the tendon. Rotator cuff tears are most common in a person’s dominant arm.

Types of Rotator Cuff Tears

Orthopedists classify rotator cuff tears by severity and cause:

• Partial vs. Full-Thickness Tears: A partial-thickness tear damages the tendon but doesn’t go all the way through. A full-thickness tear (also called a complete tear) means the tendon has pulled away entirely from the bone.
• Acute vs. Degenerative Tears: Acute tears typically result from a sudden injury, such as falling on an outstretched arm. Degenerative tears develop over time due to repetitive stress or wear and tear.
• Small vs. Large Tears: Small rotator cuff tears measure less than one centimeter, but they may grow if left untreated. Medium tears measure up to three centimeters, large tears measure three to five centimeters, and those larger than five centimeters are labeled “massive” tears.

Symptoms of a Rotator Cuff Tear

The primary rotator cuff tear symptom is a weakened, painful shoulder that makes daily life more difficult. Even simply brushing your hair can cause severe pain.

Key symptoms of a rotator cuff tear include:

• Pain, even while at rest, especially when lifting or lowering the arm or lying on the affected shoulder
• Weakness in rotating or lifting the arm
• Limited range of motion
• Crackling or popping sensations when moving the arms in specific directions

What Causes Rotator Cuff Tears?

Rotator cuff tears can be caused by:

• Acute Injury: A sudden trauma, such as falling on an outstretched arm
• Degeneration: Natural wear and tear, common in people over 40*
• Repetitive or Sports Injury: Repetitive overhead motions such as swimming, tennis, painting, or carpentry

*In older adults, a naturally decreased blood supply can impair the body’s natural ability to heal from microscopic damage, which can ultimately lead to a tendon tear. Degenerative tears may be found in one or both shoulders, even if the patient experiences no pain in the “unaffected” shoulder. And bone spurs can develop and rub on the rotator cuff tendon, especially when lifting the arms. This condition is called shoulder impingement.

How is a Rotator Cuff Tear Diagnosed?

To diagnose a rotator cuff tear, your orthopedist will carefully examine your shoulder, checking for tenderness or shoulder deformities. Your doctor will test your arm and grip strength and measure your range of motion in both the affected and unaffected arm. They will also check for other conditions that can mimic a rotator cuff tear, such as a pinched nerve or arthritis.

Imaging may be used to confirm your diagnosis, including:

• X-rays may show a small bone spur or other structural changes. (Note: X-rays do not show soft tissues like tendons; these tests are mainly to rule out other conditions such as arthritis or fractures.)
• Magnetic resonance imaging (MRI) or ultrasound can show soft tissue details, including the location, size, and age of the tear.