Rotator cuff tears rank among the most common shoulder injuries, affecting millions each year. Nearly 2 million people in the United States visit their doctor annually for rotator cuff issues. Whether it’s from an acute injury or wear and tear over time, understanding this condition and its treatment options is crucial. By doing so, you can restore shoulder function and return to pain-free movement.

• What is the Rotator Cuff?
• What are the Symptoms of a Rotator Cuff Tear?
• What Causes a Rotator Cuff Tear?
• How is a Rotator Cuff Tear Diagnosed?
• What Treatments are available for a Rotator Cuff Tear?
• When is Surgery needed for a Rotator Cuff Tear?
• What is the Prognosis for a Rotator Cuff Tear?

A rotator cuff tear causes significant shoulder pain and can limit everyday activities. It may result from a sudden injury or develop gradually due to wear and tear. Knowing the causes and symptoms can help you get back to your routine.

The rotator cuff consists of four muscles and tendons that surround the shoulder joint. These muscles keep your upper arm bone securely in your shoulder’s shallow socket. The rotator cuff is essential for lifting and rotating your arms. It plays a crucial role in many of your shoulder movements.

Types of Tears

Rotator cuff tears can vary in severity:

• Partial Tear: This type of tear frays or damages the tendon but it is not detached from the bone
• Complete Tear: Also known as a full-thickness tear, this tear goes all the way through the tendon or detaches it entirely from the bone.

Location of Tear

All four tendons of the rotator cuff can suffer damage. Sometimes, more than one tendon tears.

• Supraspinatus: Located at the top/back of the shoulder, this tendon is most often torn.
• Infraspinatus: Found in the lower back of the shoulder, it is often torn with the supraspinatus.
• Subscapularis: This tendon runs across the front of the shoulder.
• Teres Minor: Located in the lower part of the shoulder, this tendon is rarely affected.

How Common Are Rotator Cuff Tears?

Rotator cuff tears are widespread, especially in older adults and those who frequently use their arms overhead. They are a leading cause of shoulder pain and disability, prompting millions to seek medical help each year.

Rotator cuff tears cause a range of symptoms, from mild discomfort to severe pain and weakness.  It is common for a rotator cuff tear to cause pain with overhead lifting.  The pain associated with a rotator cuff tear may interfere with sleep.

Can You Move the Shoulder with a Rotator Cuff Tear?

Yes, you can often still move your shoulder, but it might hurt or feel limited. Some people experience a dull ache in the shoulder, while others struggle to lift their arm or reach behind their back.  Simple activities like brushing hair or getting dressed can become painful and difficult.

Why Does It Hurt to Sleep?

Sleeping can be painful because certain positions put pressure on the rotator cuff. Many people with rotator cuff tears have trouble sleeping. Lying on the injured shoulder may not be possible due to pain. Frequent tossing and turning at night could indicate a problem with the rotator cuff.

Rotator cuff tears can happen for several reasons:

• Injury: A sudden event, like falling on an outstretched arm or lifting something too heavy, can cause a tear.
• Wear and Tear: Repetitive motions and normal wear over time can lead to tears. These degenerative tears are more common as you age.

Risk Factors

Certain factors can increase your risk of developing a rotator cuff tear:

• Age: People over 60 face a higher risk.
• Occupation: Jobs that require repetitive overhead movements, such as painting or construction, can lead to injuries.
• Sports: Activities like baseball, tennis, and weightlifting put stress on the rotator cuff.
• Family History: A genetic predisposition might exist, as rotator cuff tears often run in families.

To diagnose a rotator cuff tear, doctors use physical exams and imaging tests.

Exam

Your doctor will perform a physical exam, checking your range of motion and muscle strength. They’ll ask about your symptoms and perform tests to determine where the pain originates and how severe the tear is.

X-rays

Doctors often use X-rays to rule out other causes of shoulder pain, such as arthritis. X-rays don’t show soft tissues like tendons, but they can reveal bone spurs or other issues that could contribute to rotator cuff problems.

MRI

An MRI is the most common test for diagnosing rotator cuff tears. It provides detailed images of the shoulder’s soft tissues. This helps the doctor see the tear’s location, size, and the condition of the surrounding muscles.

Treatment depends on the severity of the injury and your specific needs. Options range from conservative methods to surgery.

Medications

Over-the-counter pain relievers like acetaminophen and NSAIDs (e.g., ibuprofen) can help manage pain and reduce inflammation.  For mild symptoms this is often the first line of treatment.

Injection

Corticosteroid injections into the shoulder joint offer temporary relief from pain and inflammation. While effective, they are usually not a long-term solution and are often used with other treatments.  Patients that are unable to take oral NSAIDs or do not achieve adequate pain relief with oral medications may get better and longer lasting pain relief with a cortisone injection.

Recent studies show that Platelet-Rich Plasma (PRP) injections can provide better pain relief and longer-lasting results compared to cortisone injections. PRP injections are done in a typical office visit.

Physical Therapy

Physical therapy is often the first treatment for rotator cuff tears. A physical therapist will guide you through exercises that strengthen shoulder muscles, improve flexibility, and restore range of motion.

The primary focus of the non-surgical treatments for a rotator cuff tear are symptom relief and return to function.  Unfortunately, a complete rotator cuff tear is not able to heal on its own.   If pain continues and function remains limited, despite medications and therapy, surgery is often the only way to eliminate the pain and restore normal function in the shoulder.

Surgery

Surgery may be needed if non-surgical treatments fail, especially for complete tears. Surgical options include:

• Arthroscopic Surgery: A minimally invasive procedure using small instruments and a camera to repair the tear.
• Open Surgery: Involves a larger incision for more complex injuries.
• Mini-Open Surgery: Combines arthroscopic and open techniques.

Modern rotator cuff surgery is performed arthroscopically as an outpatient procedure. The surgery typically lasts about 2 hours and is done under general anesthesia.  During the surgery the detached tendon is reattached to the bone to allow healing of the tendon back to the bone.  The healing process takes about 6 weeks and restricted use and movement of the shoulder is required after surgery to allow time for the healing to occur.

Surgery is generally recommended in 2 different scenarios:
1.   In active patients who need full function of the shoulder.  Full motion, normal strength, and the ability to use the arm in overhead positions may be difficult with non-surgical treatment of a rotator cuff tear.  In these situations surgery is often recommended to improve the chances of a complete recovery.

2.  Continued pain after non-surgical treatment.  If medications, injections, and physical therapy have not provided adequate relief of pain or satisfactory improvement in shoulder motion or strength, surgery may be indicated.

The outlook depends on the severity of the tear and the treatment.

Non-Surgical

The main goal of non-surgical treatment is to reduce pain and improve shoulder function. This approach can be successful for people with less demanding lifestyles. Partial tears may heal with non-surgical treatment, especially when combined with regenerative treatments like PRP. Complete tears, especially those that retract, are unlikely to heal without surgery.

Surgical

Complete tears or partial tears that continue to cause pain, weakness, or limited shoulder function are best treated with surgery. The damaged tendon is removed, and the healthy tendon is reattached to the bone.

The tendon generally takes about 6 weeks to fully heal back to the bone. During this time, you will need to wear a sling and avoid using your shoulder. You should not use your shoulder for overhead activities or heavy lifting until the tendon is fully healed. Physical therapy and home exercises will help minimize stiffness and weakness. Full recovery, including a return to normal strength and activity, typically takes several months. However, low-impact activities, such as desk work, are usually allowed within a week or two after surgery.

With proper treatment, most patients with a rotator cuff tear are able to resume their normal lifestyle, including exercise and physically demanding activity without pain.