A rotator cuff tear occurs when one of the tendons of the rotator cuff is torn from the bone from overuse or injury.
There are two types of rotator cuff tears:
- A partial tear occurs when a tear does not completely sever the attachments to the bone
- A complete, full thickness tear means that the tear goes all the way through the tendon. It may be as small as a pinpoint, or the tear may involve the entire tendon. With complete tears, the tendon has come off (detached) from where it was attached to the bone. This kind of tear does not heal on its own
Prevention
Avoid repetitive overhead movements. Exercises to strengthen shoulder and arm muscles can also help prevent rotator cuff problems. Practice good posture to keep your rotator cuff tendons and muscles in their right positions.
Causes
Rotator cuff tears may occur in two ways:
- A sudden acute tear may happen when you fall on your arm while it is stretched out. Or, it can occur after a sudden, jerking motion when you try to lift something heavy
- A chronic tear of the rotator cuff tendon occurs slowly over time. It is more likely when you have chronic tendinitis or impingement syndrome. At some point, the tendon wears down and tears
Symptoms
The pain with a sudden tear after a fall or injury is usually intense. Right after the injury, you will likely have weakness of the shoulder and arm. It may be hard to move your shoulder or raise your arm above the shoulder. You may also feel snapping when trying to move the arm.
With a chronic tear, you often do not notice when it began. This is because symptoms of pain, weakness, and stiffness or loss of motion worsen slowly over time.
Rotator cuff tendon tears often cause pain at night. The pain may even wake you. During the day, the pain is more tolerable, and usually only hurts with certain movements.
Over time, the symptoms become much worse, and are not relieved by medicines, rest, or exercise.
Diagnosis
A physical examination may reveal tenderness over the shoulder. Pain may occur when the shoulder is raised overhead. There is often weakness of the shoulder when it is placed in certain positions.
X-rays of the shoulder may show a bone spur or change in the position of the shoulder. It can also rule out other causes of shoulder pain, such as arthritis.
Your health care provider may order other tests:
- An ultrasound test uses sound waves to create an image of the shoulder joint. It can show a tear in the rotator cuff
- MRI of the shoulder may show swelling or a tear in the rotator cuff
- With a joint x-ray (arthrogram), the provider injects contrast material (dye) into the shoulder joint. Then an x-ray, CT scan, or MRI scan is used to take a picture of it. Contrast is usually used when your provider suspects a small rotator cuff tear
Treatment
Rest and physical therapy may help with a partial tear if you do not normally place a lot of demand on your shoulder.
Surgery to repair the tendon may be needed if the rotator cuff has a complete tear. Surgery may also be needed if the symptoms do not get better with other treatment. Most of the time, arthroscopic surgery can be used. Large tears may need open surgery (surgery with a larger incision) to repair the torn tendon.
Recovery
With rotator cuff tears, treatment often relieves symptoms. But outcome depends on the size of the tear and how long the tear has been present, the person’s age, and how active the person was before the injury.
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