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Rotator Cuff Tear Overview

by Jaydee Vykoukal, PT, DPT October 20, 2020 0 Comments

shoulder pain

A rotator cuff tear is the most common cause of chronic shoulder pain. In 2013, nearly 2 million people in the U.S. visited their healthcare provider due to a rotator cuff problem. A torn rotator cuff weakens the shoulder, making daily activities difficult to accomplish. If you think you are suffering from a rotator cuff tear, read on to learn about the different types, symptoms, and root causes, along with effective treatment options.

What is a Rotator Cuff Tear?

The shoulder is a ball-and-socket joint that consists of three bones: the collarbone (clavicle), the shoulder blade (scapula), and the upper arm bone (humerus). While the shoulder joint capsule and ligaments keep the joint in place, the rotator cuff helps keep your arm in an optimal position. It provides stability and strength to the shoulder with movements like reaching and lifting. Between the acromion (bone on top of your shoulder) and the rotator cuff is a lubricating sac known as a bursa. If there is a tear in your rotator cuff, which means the tendons are damaged or injured, the bursa can become painful and inflamed along with the tendons themselves.

When the rotator cuff tendon is torn, the severity of it determines if it affects shoulder stability. There are four muscles in the rotator cuff: the supraspinatus, infraspinatus, teres minor, and subscapularis. In many cases, a rotator cuff tear occurs in the supraspinatus tendon, but other tendons may also be involved. Damaged tendons often start by fraying and can completely tear as the injury worsens. Although a sudden injury can occur as well from a fall or impact. 

Types of Rotator Cuff Tears

Rotator cuff tears range from mild to severe. Understand the different types to receive proper diagnosis and treatment. Rotator cuff tear injuries fall into one of three categories.

  • Partial Rotator Cuff Tear

    In a partial rotator cuff tear, some muscle fibers are torn without affecting the integrity of the joint. Most often, the tendon that protects the top of your shoulder (the supraspinatus) is damaged or frayed. The rotator cuff is thick, like any tendon, and this type of injury happens when a portion of the rotator cuff (less than 50% of the fibers) pulls away from the bone.

  • Full Thickness Rotator Cuff Tear

    A full thickness rotator cuff tear is also called a complete rotator cuff tear, although any tear greater than 50% is considered full thickness. This type of injury separates all the fibers of a specific muscle tendon from the bone. This leaves the shoulder vulnerable to instability and significantly weak due to complete loss of muscle function. Often, this will result in the need for surgery and a sling.

  • Massive Rotator Cuff Tear

    In a massive rotator cuff tear, two or more of the four muscles are damaged and are no longer attached to the bone. This injury usually causes significant pain, especially at night, which can become unbearable. While this can occur at any age with a high impact injury (from a sport, fall or car accident), it is now linked to aging and shoulder degeneration which result in muscle retraction and significant atrophy.

Causes of Rotator Cuff Tear

When the rotator cuff is torn, a variety of serious problems arise. How do you tear your rotator cuff? The two main causes of rotator cuff tear are:

Acute Tear

An acute rotator cuff tear is caused by an injury or trauma, such as lifting something too heavy or falling on your outstretched arm. This type of tear can happen with other serious shoulder conditions, such as a  dislocated shoulder or a broken collarbone.

Degenerative Tear

A degenerative tear is the result of wear and tear of the tendon, which happens slowly as you age or overuse the joint with repetition motion and sports. This is why people aged 40 and above are at greater risk. Rotator cuff tears are more common in the dominant arm. So if the patient has a tear in one shoulder, there is a chance that the opposite shoulder is damaged as well, even if there are no symptoms present. Many factors contribute to a degenerative rotator cuff tear. These include bone spurs, repetitive stress, and lack of blood supply.

    Rotator Cuff Tear Symptoms

    If you think that you may have a rotator cuff tear, you should know what symptoms to watch out for. If you experience one or more of the most common rotator cuff tear symptoms, consult your doctor immediately to prevent long term unnecessary suffering. 

    • Weakness- particularly with lifting the arm overhead or resisted rotation
    • Discomfort while resting and at night
    • Intense pain when lowering or lifting the arm
    • Pain that radiates through the affected arm
    • A popping or crackling sensation
    • Waking up with a dull ache deep in the shoulder
    • Difficulty combing your hair or reaching behind your back
    • Pain when getting dressed

    Rotator Cuff Tear Diagnosis

    See your doctor right away if you are experiencing any of the symptoms listed above. Early and accurate rotator cuff tear diagnosis is necessary to regain shoulder function and relieve your pain. Your doctor will use the following methods to diagnose your rotator cuff tear. 

    Strain vs. Tear

    There is a lot of overlap between the terms rotator cuff strain and tear. A strain implies there is damage to a muscle or tendon. Whereas a tear implies there has been an actual ripping of the muscle fibers or attached tendon. Moderate to severe strains can result in a tear. Healthcare professionals tend to be more concerned about tears because of their effect on function.

    Medical History and Physical Examination

    Your doctor will ask about your medical history, general health, and symptoms before performing different rotator cuff tear tests to check your shoulders for deformity, function,, and tenderness. Your doctor will also evaluate your arm strength.

    To test your range of motion, expect your arm to be moved in different directions. Decreasing strength may indicate that the tear is getting larger or you’ve been resting the arm for too long secondary to pain. To ensure your pain is not caused by a pinched nerve or arthritis, your doctor may also examine your neck.

      Rotator Cuff Tear X-Ray

      The first imaging test that might be conducted is often an X-ray, which produces an image of the shoulder joint itself. This can help determine if there are bone spurs, calcified tendons, any other signs of arthritis, or fracture. Imaging is not always necessary and will depend on your symptoms and injury cause.

        Rotator Cuff Tear MRI

        If a partial or complete tear is suspected, an MRI scan can better show a rotator cuff tear, giving your doctor a clear image of how severe the injury is. This diagnostic imaging study can display the health of the rotator cuff muscles, the size of the tear, and where the injury is located within the tendon. Again, this is not always necessary.

          Ultrasound

          If needed, an ultrasound can help your doctor diagnose your rotator cuff tear. This test shows the soft tissues (the bursa, tendons, and muscles) in your shoulder.

            Rotator Cuff Tear Recovery Time

            If the tear is 50% or more of the fibers, surgery or significantly more rest may be required for proper healing. A smaller tear or strain will probably respond really well to more conservative treatment.

            In some cases, six months or more of rehabilitation is required to regain shoulder strength, function, and a full range of motion. When surgery is required it takes approximately four to six months

            Rotator cuff treatment will often result in rest, pain management, physical therapy, and possibly surgery. Pain, severity of the tear, your age, and other factors will determine which treatments are best for you. The key is to reduce pain while restoring shoulder function with the least invasive option possible. These cases typically take 6-12 weeks to heal.

            Continue through our guide on rotator cuff tears to learn more about treatments for quick recovery.

            Sources:

            https://orthoinfo.aaos.org/en/diseases--conditions/rotator-cuff-tears

            https://www.howardluksmd.com/education/common-injuries/rotator-cuff-tears-is-surgery-necessary/

            https://www.howardluksmd.com/orthopedic-social-media/massive-rotator-cuff-tears-treatment-options-for-a-complex-problem/

            https://paindoctor.com/conditions/rotator-cuff-tears/

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            Jaydee Vykoukal, PT, DPT
            Jaydee Vykoukal, PT, DPT

            JayDee Vykoukal is a Doctor of Physical Therapy, owner of the healthy habit platform Health Means Wealth, and freelance medical writer. She loves traveling and spending time with her family in nature. Her passion is helping others continue to participate in the activities they love through education and proper exercise.



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