Rotator Cuff Tears

The shoulder joint is a ball and socket type of joint. The rotator cuff is a group of four muscles (supraspinatus, infraspinatus, teres minor, and subscapularis) and their tendons which act together to hold the upper arm (humerus) in place at the shoulder joint and allow it to move in various directions.

When one of the rotator cuff tendons (usually the supraspinatus) become inflamed (tendonitis), they are at risk of being torn. In fact, most rotator cuff tears occur in people who already have rotator cuff tendonitis which has become so bad that the tendon wears away to the point where a tear develops. However, rotator cuff tears can also occur suddenly from acute trauma, such as falling on the shoulder or trying to lift something that may be too heavy. When this type of injury happens, immediate pain is usually felt at the shoulder and a popping sound may also be heard at the time the rotator cuff is torn. If the tear occurs due to chronic and severe tendonitis, symptoms may include: pain with lifting the arm overhead, difficulty sleeping on the side of the injured shoulder, stiffness of the shoulder caused by decreased use of the arm secondary to pain, and weakness of the arm with overhead activities.

The condition is diagnosed by taking a thorough history and performing a detailed physical examination, which involves special tests aimed at detecting the strength and integrity of the rotator cuff muscles. Sometimes, an X-ray may be ordered and may show a bone spur located under the acromion (bony protuberance of the shoulder blade also known as the scapula). This bone spur can and usually contributes to a rotator cuff tear. Another imaging study often used is an MRI. This test looks at the soft tissues of the shoulder joint and can show in great detail the location and degree of tear of the tendon involved.

Once diagnosed, a treatment plan is devised and is often dependent on the degree of rotator cuff tear. This can consist of conservative measures such as pain and anti-inflammatory medication, local steroid injections into the joint, and physical therapy. Physical therapy helps by restoring range of motion to the shoulder joint, strengthening the remaining muscles of the rotator cuff in order to ease the load placed on the injured tendon during overhead activities, and improving overall function of the shoulder. If conservative measures fail, however, or if the tear occurs in an athlete or someone who requires maximum strength of the arm for overhead work, surgery may be required.