Rotator Cuff Tears
UW Health's Sports Medicine doctors in Madison, Wisconsin, treat a wide range of common athletic injuries, including rotator cuff tears.
About the Rotator Cuff
The rotator cuff is a group of four muscles and tendons that help provide stability and mobility to the shoulder. The four muscles include the supraspinatus, infraspinatus, teres minor and subscapularis.
The muscles connect the upper arm (humerus) to the shoulder blade (scapula) forming a “cuff” around the humerus. Each muscle originates on the scapula and has a tendon that attaches to the humerus. The supraspinatus tendon is the most frequently torn tendon in the shoulder.
Tears to the rotator cuff can be caused by an acute injury such as a fall, lifting or pulling, or lifting too much overhead. Chronic tears are more common and are caused by degenerative changes over the years. People over 40 years of age have an increased risk of rotator cuff tears just from normal wear and tear of daily life that breaks down the rotator cuff muscles and tendons. Age can also predispose a person to calcium deposits within the cuff or bone spurs that irritate the cuff and cause a tear.
Tears can be caused by repetitive stress such as what an athlete might do in overhead sports such as swimming, baseball or volleyball. People that do repetitive activities in their jobs such as painting or hammering can also be at an increased risk to tears. Injuries such as dislocating the shoulder may weaken and tear the cuff. Also, having certain bony shapes in the bones around the shoulder (especially the acromion process on the scapula) may predispose a person to a rotator cuff tear.
Signs and Symptoms
One of the biggest complaints of both acute and chronic rotator cuff tears is pain at night while trying to sleep. In addition, patients often describe shoulder pain near the tear, radiating pain down the upper arm, and limited range of motion (ROM) especially when lifting the arm to the side away from the body. Chronic symptoms also can include muscle weakness (atrophy), joint noise in the shoulder (crepitus), and the inability to move the arm fully, especially forward or sideways from the body.
In order to diagnose this condition, the medical providers will ask you questions about your injury and also perform a physical examination of the involved area, which will include movement tests and strength assessment. In addition, x-rays may be needed to further assess the alignment and cartilage spaces of the shoulder or to rule out other potential bone abnormalities. Further imaging, such as an MRI, may be indicated to get a better picture of the tendons, ligaments and joint if initial treatment does not improve symptoms.
Factors that determine treatment include the size of the tear, patient age, symptoms and functional goals. Sports rehabilitation professionals help to decrease pain, address strength deficiencies and correct biomechanics. Home exercise programs also become important to optimize overall progress and functional independence.
The physician may prescribe non-steroidal anti-inflammatories or perform a cortisone injection into the subacromial bursa. If conservative treatments fail, surgery may be required to repair the torn rotator cuff.
If surgery is indicated, the exact type of surgery used will depend on individual factors such as location and grade of the tear, the presence or absence of bone spurs, and goals for return to work and/or sport.
Recovering from a rotator cuff surgery will take approximately six to 12 months. Rehabilitation is an important component of care following surgery. Sports medicine professionals can help answer any questions you have about rotator cuff injuries and the things you can do to get better.