A rotator cuff tear is a common condition affecting the shoulder. If you have a torn rotator cuff tear it is possible to limit your daily activities, such as getting dressed or raising your hands above your head.
Muscles/Tendons of the Rotator Cuff
The shoulder is a ball-and-socket joint, called the glenohumeral joint. The rotator cuff is made up of 4 muscles; the infraspinatus, supraspinatus, subscapularis, and teres minor. Together these muscles contribute to the stability of the shoulder. The cuff adheres to the glenohumeral capsule and attaches to the humeral head.
The 4 tendons of these muscles converge to form the rotator cuff tendon. The supraspinatus is the most common muscle tendon that is torn in the rotator cuff.
Bones of the Shoulder
There are 3 bones that together form the shoulder joint (or glenohumeral joint), the clavicle, the humerus, and the scapula.
In order for the shoulder joint to work you need ligaments, muscles, and tendons to help support the bone.
Classification of Tears
There are several different types of rotator cuff tendon tears, partial thickens tears, and full thickness tears with complete detachment of the tendons from bone. Once a rotator cuff is torn, the tendon no longer fully attaches to the head of the humerus.
Partial Tear – Often seen as a fraying of the soft tissue. These tears are not completely
Full Thickness Tear – These tears can be small or large.
A rotator cuff tear can be acute or chronic.
Acute – Happens from a fall or jerking motion.
Chronic – The wearing down process happens over a long period of time
Symptoms of Acute Tears –
- Feeling a tear in the shoulder followed by severe pain in the shoulder and arm.
- Tenderness to touch.
- Restricted movement (limited range of motion) due to pain in the shoulder.
Symptoms of Chronic Tears –
- Pain that becomes worse as time goes on.
- Pain when lifting your arm to the side.
- Pain may become more noticeable at night.
The shoulder will be examined, looking for tenderness and deformity. There are stress tests or impingement testing that can be done to measure the range of motion of your shoulder. This testing is done in the office and should only be done by the physician. The neck may also be examined to check for a pinched nerve.
There are several types of tests that can be ordered to help aid in the diagnosis of a Rotator Cuff Tear, these include:
X-ray – X-rays are often ordered to rule out any boney abnormalities. Soft Tissues do not show up well on plain x-rays however, it helps in locating any bone spurs that may be contributing to some of the pain.
Ultrasound – Ultrasound studies are also a means of identifying rotator cuff tears. Ultrasound transmits high-frequency sound pulses into your body using a probe. The waves travel between tissues and fluid and are then reflected back to the probe and relays it to the machine.
Ultrasound is painless and there is no radiation involved. Ultrasound is not always able to take the place of an MRI but it is faster, no exposure to radiation and less expensive than an MRI. They can also be used in the presence of metal, eg. Or for patients who are claustrophobic. Ultrasounds can be done at the time of the visit in the office.
MRI – Magnetic Resonance Imaging – A painless technique that allows the doctor to look at the soft tissues of the shoulder. They help identify not only if there is a tear but the location and size of the tear.
Rest – avoid certain activities, such as, overhead activity.
Physical Therapy Exercises – Supervised physical therapy that will help to restore strength in your shoulder.
Steroid Injection – A mixture of a local anesthetic and cortisone can be injected into the shoulder.
If conservative treatments fail surgery maybe recommended. Surgical repairs are almost always done arthroscopically. The size and type of tear will determine the type of repair that is needed. The surgery re-attaches the tendon to the head of the humerus using anchors.