Rotator Cuff Tear

ExitCare ImageThe rotator cuff is four tendons that assist in the motion of the shoulder. A rotator cuff tear is a tear in one of these four tendons. It is characterized by pain and weakness of the shoulder. The rotator cuff tendons surround the shoulder ball and socket joint (humeral head). The rotator cuff tendons attach to the shoulder blade (scapula) on one side and the upper arm bone (humerus) on the other side. The rotator cuff is essential for shoulder stability and shoulder motion.

SYMPTOMS

  • Pain around the shoulder, often at the outer portion of the upper arm.

  • Pain that is worse with shoulder function, especially when reaching overhead or lifting.

  • Weakness of the shoulder muscles.

  • Aching when not using your arm; often, pain awakens you at night, especially when sleeping on the affected side.

  • Tenderness, swelling, warmth, or redness over the outer aspect of the shoulder.

  • Loss of strength.

  • Limited motion of the shoulder, especially reaching behind (reaching into one's back pocket) or across your body.

  • A crackling sound (crepitation) when moving the shoulder.

  • Biceps tendon pain (in the front of the shoulder) and inflammation, worse with bending the elbow or lifting.

CAUSES

  • Strain from sudden increase in amount or intensity of activity.

  • Direct blow or injury to the shoulder.

  • Aging, wear from from normal use.

  • Roof of the shoulder (acromial) spur.

RISK INCREASES WITH:

  • Contact sports (football, wrestling, or boxing).

  • Throwing or hitting sports (baseball, tennis, or volleyball).

  • Weightlifting and bodybuilding.

  • Heavy labor.

  • Previous injury to rotator cuff.

  • Failure to warm up properly before activity.

  • Inadequate protective equipment.

  • Increasing age.

  • Spurring of the outer end of the scapula (acromion).

  • Cortisone injections.

  • Poor shoulder strength and flexibility.

PREVENTION

  • Warm up and stretch properly before activity.

  • Allow time for rest and recovery between practices and competition.

  • Maintain physical fitness:

  • Cardiovascular fitness.

  • Shoulder flexibility.

  • Strength and endurance of the rotator cuff muscles and muscles of the shoulder blade.

  • Learn and use proper technique when throwing or hitting.

PROGNOSIS

Surgery is often needed. Although, symptoms may go away by themselves.

RELATED COMPLICATIONS

  • Persistent pain that may progress to constant pain.

  • Shoulder stiffness, frozen shoulder syndrome, or loss of motion.

  • Recurrence of symptoms, especially if treated without surgery.

  • Inability to return to same level of sports, even with surgery.

  • Persistent weakness.

  • Risks of surgery, including infection, bleeding, injury to nerves, shoulder stiffness, weakness, re-tearing of the rotator cuff tendon.

  • Deltoid detachment, acromial fracture, and persistent pain.

TREATMENT

Treatment involves the use of ice and medicine to reduce pain and inflammation. Strengthening and stretching exercise are usually recommended. These exercises may be completed at home or with a therapist. You may also be instructed to modify offending activities. Corticosteroid injections may be given to reduce inflammation. Surgery is usually recommended for athletes. Surgery has the best chance for a full recovery. Surgery involves:

  • Removal of an inflamed bursa.

  • Removal of an acromial spur if present.

  • Suturing the torn tendon back together.

Rotator cuff surgeries may be preformed either arthroscopically or through an open incision. Recovery typically takes 6 to 12 months.

MEDICATION

  • If pain medicine is necessary, then nonsteroidal anti-inflammatory medicines, such as aspirin and ibuprofen, or other minor pain relievers, such as acetaminophen, are often recommended.

  • Do not take pain medicine for 7 days before surgery.

  • Prescription pain relievers are usually only prescribed after surgery. Use only as directed and only as much as you need.

  • Corticosteroid injections may be given to reduce inflammation. However, there is a limited number of times the joint may be injected with these medicines.

HEAT AND COLD

  • Cold treatment (icing) relieves pain and reduces inflammation. Cold treatment should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain and immediately after any activity that aggravates your symptoms. Use ice packs or massage the area with a piece of ice (ice massage).

  • Heat treatment may be used prior to performing the stretching and strengthening activities prescribed by your caregiver, physical therapist, or athletic trainer. Use a heat pack or soak the injury in warm water.

SEEK MEDICAL CARE IF:

  • Symptoms get worse or do not improve in 4 to 6 weeks despite treatment.

  • You experience pain, numbness, or coldness in the hand.

  • Blue, gray, or dark color appears in the fingernails.

  • New, unexplained symptoms develop (drugs used in treatment may produce side effects).