What are Rotator Cuff Tears?
Rotator cuff tears are one of the most common shoulder conditions, and are painful and cause the patient to have limited range of motion. Those with a rotator cuff tear will often find that they are not able to lift their injured arm above the shoulder, and will notice a decrease in the ability to perform tasks such as brushing their hair, reaching for a high shelf, or holding objects at eye level. Weakness and tenderness of the area are also very common. Sleep is often interrupted, as this injury can be aggravated by lying on the injured shoulder.
It is estimated 2 million Americans visit their physician annually for rotator cuff tears. Such an injury can cause nagging, aching pain that limits daily activities; don’t think professional baseball — although pitchers are prone to such injury. Think the average Joe who has to wince his way through pulling a shirt over his head, or raising his arm to comb his hair.
The rotator cuff consists of tendons and muscles that connect the upper bone of your arm to your shoulder blade, and assist in holding the joint of the shoulder together. A rotator cuff complication can occur through injury, trauma, or repetitive motion such as playing pitcher for a baseball team.
A rotator cuff becomes torn when one of the tendons is injured. The tendon no longer attaches properly to the top of the humerus bone. The most common tear is in the supraspinatus muscle and tendon. This can cause an inflammation of the acromion, which may cause additional pain. There are several types of tears: partial, full-thickness, acute and degenerative.
How Do Rotator Cuff Tears Happen?
The causes of these tears are most likely injury — often from lifting something too heavy over head, or repetitive stress. Think again about that professional baseball pitcher. Throwing the ball over and over again can wear away the tendons, causing a rotator cuff tear.
A lack of blood supply to the area, caused with age, can also reduce the body’s natural ability to repair itself. If a tendon is already slightly injured and the blood supply is diminished, a tear can occur. Most rotator cuff tears are caused from a combination of repetitive and degenerative causes; those age 40 and older are most at risk.
There are different types of rotator cuff problems that may arise, including bursitis, tendinitis, straining/tearing of the ligaments. The bursa is small and sac-like, filled with fluid to aid in the smooth motion of the shoulder. Bursitis, a type of rotator cuff disorder, is the condition that occurs when the bursa becomes inflamed or sustains prolonged irritation. Tendinitis is often seen in athletes who play tennis or racquetball frequently and for long periods of time. It is characterized by tendons that have become inflamed due to their overuse. If tendinitis is not caught soon enough and is left untreated, it can progress into tendon strain or tendon tear. And lastly, aging can be a factor in rotator cuff disorders. As we age, our tendons may lose some of their initial integrity, which can lead to wearing, straining and tearing of the tendon.
Degenerative symptoms include: pain if lying on the shoulder at rest, or when lifting and lowering the arm; weakness in the limb, especially when rotating the arm; or a crackling noise when moving the arm. When a tear is caused from a sudden injury, such as falling off a ladder or a car accident, there may be a snapping noise, followed by intense pain and a weakness in the arm.
A pain physician will rule out arthritis and a pinched nerve during examination. The physician will have the patient move the arm in specific directions to determine the source of the pain, and may test for arm strength. X-rays are unable to show soft tissue, so an MRI and ultrasound will likely be ordered to confirm the tear diagnosis. The MRI should provide the size and location of the tear, and the physician may be able to determine from the image how old the injury is.
Treatment for rotator cuff problems should begin as conservatively as possible, and may include resting, applying ice packs to the shoulder and taking over-the-counter medications including non-steroidal anti-inflammatory drugs (NSAIDs), including aspirin and ibuprofen. Non-surgical treatment for rotator cuff tears include: rest, avoiding activities that cause pain, non-steroidal anti-inflammatory over the counter medications, like Aleve, physical therapy and steroid injections. Should these conservative treatments fail, consultation with your physician is the next step to be taken. Your doctor may recommend injections consisting of corticosteroids to aid in the reduction of inflammation and pain. In addition, your physician may recommend physical therapy and reconditioning. If the tear in the rotator cuff is significant, surgery may be indicated.
The most important information to take note of is that rotator cuff injuries can be prevented. By taking care not to hyper-extend the shoulder and preventing overuse, injuries to the rotator cuff may be able to be avoided. Care should be taken by athletes to use correct form, and to always rest and apply ice packs should they feel any pain or fatigue in the shoulder.
Half of all rotator cuff tear patients report pain relief without surgery; however these options do not improve the strength of the shoulder — the only minimize pain. If a patient’s pain doesn’t improve, the physician may recommend surgery to repair the tendon and tear.