Rotator Cuff Tear
A rotator cuff tear often occurs in people who repeatedly perform the same shoulder motions. The rotator cuff is a group of tendons that connects the shoulder blade to the upper arm and allows you to rotate and lift your arm. If any of these tendons develops a tear, it can cause pain, weakness, stiffness, and limited range of motion. Treatments ranging from physical therapy to rotator cuff surgery can repair the torn tendon(s), alleviate symptoms, prevent irreversible damage, and allow you to return to normal activities.
In most cases, a rotator cuff tear is the result of repeated shoulder motions causing progressive wear and tear of the tendons. It can also occur due to a traumatic injury. Symptoms can include:
- Pain while doing daily activities like getting dressed, combing hair, and any other activity that involves lifting or rotating the arm
- Difficulty performing daily activities that involve lifting or rotating the arm
- Weakness in the upper arm and shoulder
- Stiffness and decreased range of shoulder motion
- Pain that worsens during the night
Patients with a torn rotator cuff often use their injured arm less, which leads to further degeneration and the potential need for a total shoulder replacement down the line. The following treatments can help strengthen the shoulder, prevent further degeneration, and repair the damaged tendons in the rotator cuff.
- Physical Therapy: PT is usually recommended for patients with small tears (less than 1 centimeter), partial tears, and tears that occurred gradually over time. PT can help patients regain some shoulder strength and range of motion. Patients who undergo rotator cuff repair surgery will also do PT during recovery.
- Anti-Inflammatory Medication: Non-steroidal anti-inflammatory medications can decrease inflammation and pain due to a small or partial rotator cuff tear. Patients undergoing physical therapy may benefit from taking anti-inflammatory medications (over-the-counter or prescription strength) to reduce pain while they work to regain strength and mobility.
- Injections: Steroid injections may be given to patients with small or partial tears, who are not candidates for surgery, or who did not have success with physical therapy. This treatment method should be considered carefully as it can interfere with surgical healing and may actually weaken the tendons and cause a tear to enlarge.
- Rotator Cuff Surgery: For patients with larger tears, for whom conservative treatments have not worked, and for certain other candidates, surgery will be recommended to repair a torn rotator cuff. During the surgery, small anchors are used to secure the torn tendon(s) back into position. This arthroscopic procedure typically takes under 2 hours, and patients can usually go home the same day.
Frequently Asked Questions
A rotator cuff tear often occurs gradually and is usually accompanied by pain, weakness, and limited range of motion. The symptoms themselves can be enough to suspect a tear, and a diagnosis can be confirmed with a detailed history and exam (including MRI).
Because of the potential for future acute damage to the shoulder, patients with a rotator cuff tear should proceed with treatment as recommended by an orthopedic surgeon. Factors including the size of the tear, the patient’s level of function, the severity of symptoms, and the patient’s age will all play a role in determining whether the initial approach should be conservative treatments or whether to proceed immediately with surgery.
Patients who have torn their rotator cuff typically use their shoulder less, which causes the muscles in the shoulder to weaken. This can lead to muscle atrophy and irreparable damage, resulting in rotator cuff arthropathy (arthritis) and the eventual need for a total shoulder replacement. Another risk is that a rotator cuff tear may prevent you from being able to do many physical activities, including sports, work, and other daily tasks. Because these risks can severely impact your quality of life, it is recommended that you carefully consider rotator cuff repair.
Rotator cuff repair surgery is a minimally invasive procedure that begins with three to four small incisions around the shoulder joint. Through these incisions, a small camera may be inserted to allow visualization, and tools may be inserted to provide repairs. Small anchors will be inserted into the bone where the rotator cuff has torn. These anchors contain sutures which are passed through the torn tendon(s) and then tied to secure the tendon back into position. Usually, the procedure is performed under general anesthesia with a nerve block, and dressings and a sling will be placed before the patient wakes up after the surgery. Patients can usually return home the same day to begin their recovery.
A sling is a necessary part of recovery from rotator cuff repair surgery and helps the tissues remain stable as they mend and strengthen. The sling will usually be worn around the clock for 6 weeks but should be removed to perform various motion exercises as instructed (usually several times a day). Your recovery progress with physical therapy will determine when the sling can be fully removed.