Rotator Cuff Tears

The shoulder joint is called the glenohumeral joint. It is a ball and socket joint where the head of the upper arm bone (the humerus) articulates in the shallow glenoid cavity on the scapula (the shoulder blade). The large head of the upper arm bone and the shallow socket are what provide a highly mobile joint that is inherently unstable. Stabilizers include the rotator cuff, the labrum, and the surrounding tendons and muscles.

The rotator cuff is a group of four muscles and their tendons that cover the upper arm bone. The rotator cuff is the stabilizing force that allows us to raise our arms overhead. During arm movement the rotator cuff muscles prevent the dislocation of the head of the upper arm bone while maintaining stability.

Rotator cuff tears are tears in the tendons. Rotator cuff tears are a common cause of pain and disability. A tear weakens the shoulder causing even normal activities to become too painful and challenging to do.

Tears may be partial or full. A partial tear results from damage to soft tissues but does not sever the tendon. With a full thickness tear, the tendon is torn off the bone. Tears often begin as partial tears and progress to full thickness tears of the tendons with continued use.

Rotator cuff tears are common in middle-aged and older individuals. Repetitive use activities cause microtears and lead to partial and full tears in younger athletes.

The underlying cause is often multifactorial involving:

• Degenerative changes including wear and tear, and a decreased blood supply which weakens the tendon. Bone spurs that rub against the soft tissues and create a tear.
• Overuse
• Trauma from an accident, a fall, a shoulder dislocation, or collarbone fracture.

• Aging.
• Smoking.
• Steroid injections into the tendon.
• Some antibiotics.
• Gender. Rotator cuff tears are more common in women.
• Sports that involve repetitive overhead motions like tennis, golf, basketball, baseball.
• Occupational hazards from mechanical overload. Construction, carpentry, house painting. This accelerates degeneration of the tendons and can be the last straw in a traumatic rotator cuff tear as in heavy lifting.
• Family history.
• Obesity and metabolic syndrome. 

• Acute traumatic tears.
• Repetitive stress tears result from overuse.
• Degenerative tears result from slow degeneration of the joint that causes weakness and pain. Degenerative tears are often found in people over age 40.

• Symptomatic tears usually affect the dominant arm and cause severe pain and weakness.
• Shoulder pain at rest and at night, and weakness with arm rotation or lifting.
• A dull ache or pain that worsens with use.
• Decreased shoulder function, strength, and range of motion that make it challenging to perform the daily activities of life like brushing your hair, showering, and reaching for objects while shopping.
• Chronic pain in the arm and shoulder indicates the need for surgical repair because continued use can cause additional damage.

• In up to 66% of all rotator cuff tears there are no symptoms.
• Asymptomatic rotator cuff tears are prevalent in the general population.
• Asymptomatic tears are usually found in the non-dominant arm.
• Studies report that asymptomatic rotator cuff tears often become symptomatic over time with reduced shoulder function, strength, and range of motion

During your orthopedic evaluation, our team at LALL Orthopedics ⁺ will ask about your symptoms and any trauma, review your medical history, and perform a thorough physical exam. They will test your shoulder range of motion and strength, and look for tenderness. They will also evaluate the shoulder joint for other possible causes of your shoulder pain.

Imaging studies including x-rays and an MRI will reveal damage to the bones and soft tissues; and can provide information about the timing of the tear and quality of the muscles.

Treatment recommendations will depend upon the tear type and size, location, and muscle quality; and whether other bone spurs or arthritis or another condition is also present.