Rotator Cuff Tear
Although there are many reasons for shoulder pain, a common problem for
people over 40 years of age is a rotator cuff tear. The rotator cuff is
comprised of the muscles and tendons that surround the top of the upper
arm bone (humerus) and hold it in the shoulder joint. A tear may result
suddenly from a single traumatic event or develop gradually because of
repetitive overhead activities.
Causes of a Rotator Cuff Tear
Repetitive overhead motion such as pitching or painting a ceiling; heavy
lifting; excessive force, such as a fall; and degeneration due to aging,
including a reduction in the blood supply to the tendon can all lead to
rotator cuff tears.
Rotator Cuff Tear Symptoms
Symptoms of rotator cuff tears include recurrent, constant pain; muscle
weakness, especially when attempting to lift the arm; “grating”
or cracking sounds when the arm is moved; and limited motion. Rotator
cuff tears usually occur in the dominant arm (right shoulder for right-handed
people; left shoulder for left-handed people).
Rotator Cuff Tear Treatment Options
Rotator cuff tears may be partial- or full-thickness. Partial-thickness
tears do not completely sever the tendon and may respond well to non-operative
treatments. Full-thickness tears require surgery to correct. Surgery may
also be used to treat partial-thickness tears that do not respond to non-operative
Your doctor will prescribe a treatment regimen based on your injury and
your need for pain relief, movement and function. In most cases, the initial
treatment is non-surgical and will include non-steroidal anti-inflammatory
medications or corticosteroid injections to help control pain; strengthening
and stretching exercises as part of a physical therapy program; and good
old-fashioned rest. Ultrasound can enhance the delivery of topically applied
drugs and has thermal effects that may also help in the healing process.
Rotator Cuff Tear Surgical Treatment Options
There are several surgical options to treat rotator cuff tears, depending
on the size, depth, and location of the tear. If other problems with the
shoulder are discovered during the surgery, they will be corrected as
well. Surgical options include:
- Arthroscopy, in which miniature instruments are inserted into small incisions,
can be used to remove bone spurs or inflammatory portions of muscle and
to repair lesser tears.
- A mini-open repair that combines arthroscopy and a small incision can be
used to treat full-thickness tears.
- In more severe cases, open surgery is required to repair the injured tendon.
Sometimes a tissue transfer or a tendon graft is used. Joint replacement
is also an option.
It takes some time to recover from shoulder surgery. Full functioning may
not return for six months or more. Your orthopaedic surgeon will recommend
a program of exercises to strengthen and restore motion. Your commitment
to following the program outlined will make a difference in the ultimate
results. Although every case is unique, surgery can relieve pain for most
people and rehabilitation can restore functional range of motion.