Rotator Cuff Tear
The rotator cuff is a group of four tendons that attach the shoulder blade (scapula) to the upper arm (proximal humerus), allowing you to lift and rotate your arm (for more details about the specific muscles that make up the rotator cuff, please refer to the shoulder anatomy page). When one or more of these tendons is torn, this leads to pain, weakness, and limited range of motion. Depending on the size of the rotator cuff tear, surgical treatment with a shoulder arthroscopy may be the best option for the quickest and best outcome getting you back to a strong, active life.
- Difficulty lifting due to weakness
- Decreased shoulder range of motion
- Pain that is worse at night
- Pain reaching up or away from the body
- Physical Therapy - For small tears (less than 1 cm), partial tears, and tears that did not occur from an acute injury, physical therapy (PT) is the first line of treatment. PT can help patients regain their strength and range of motion and restore the mechanics of the affected joint.
- Injections - Injection of a steroid into the subacromial bursa (above the rotator cuff) can be considered for patients with rotator cuff tears less than 1 cm and partial tears, as well as for patients who fail treatment with physical therapy or who are not good candidates for surgery. Steroid injections can actually weaken the rotator cuff tendons and potentially cause the tear to enlarge. Steroids can also interfere with healing if surgery is performed, so this treatment must be considered carefully.
- Anti-inflammatories - Nonsteroidal anti-inflammatory medications such as Ibuprofen or Aleve can help decrease inflammation and pain caused by small or partial rotator cuff tears. This can be beneficial in addition to physical therapy, so patients can have less pain while regaining their motion and strength. Prescription-strength anti-inflammatory medications are occasionally prescribed.
- Surgery - For rotator cuff tears greater than 1 cm or for patients with partial tears and smaller tears that have not responded to conservative treatment, surgery to repair the torn rotator cuff tendons is recommended.
Patients with a torn rotator cuff frequently have pain that limits their range of motion in addition to weakness with lifting objects out to the side. If a rotator cuff tear is suspected after a detailed history and thorough physical exam, an MRI will likely be ordered. An MRI evaluates soft tissue structures like the rotator cuff tendons.
The size of the rotator cuff tear, the patient’s age, history of trauma, and the patient’s level of function determines whether the initial treatment should be conservative or if it would be better to proceed directly with surgery.
The most common risks are stiffness, persistent pain, and weakness. Patients with a torn rotator cuff commonly use their injured arm less, which causes the shoulder muscles to weaken. Over time, these muscles can atrophy and the tendon can become irreparable. This can lead to a condition called rotator cuff arthropathy.