Rotator Cuff Tears: Overview

Rotator Cuff Tears: Overview

The rotator cuff refers to a collection of muscles and their corresponding tendons that support the shoulder joint by keeping the ball of the upper arm bone, the humerus, centered in the socket.

Not only does the rotator cuff collectively help with stabilization of the shoulder, but each individual muscle of the rotator cuff also helps with movements of the arm such as lifting and rotation.

A tear in one of the rotator cuff tendons disrupts the balance of these muscles and results in pain and weakness with certain movements.

Rotator cuff tears in the general public are reported between 5% and 39%. The likelihood of sustaining a cuff tear increases with age, with one study demonstrating 54% of patients greater than 60 years old without symptoms have a rotator cuff tear seen on an imaging test.

In addition to age, other risk factors include trauma to the shoulder, gender, arm dominance, heavy labor, and genetic factors.

Rotator cuff tears occur in several ways. They are more likely to occur due to wear and tear to the tendons as we age over a long period of time. In addition, those who perform repetitive activities with their shoulder can have a degenerative type tear due to overuse.

Rotator cuff tears can also happen acutely due to an injury. This typically results from falling onto an outstretched hand or trying to lift a heavy object.

Fortunately, there are steps you can take to reduce your risk of sustaining a rotator cuff tear. Traditional upper body weightlifting may not strengthen the smaller muscles like the rotator cuff that helps to stabilize the shoulder joint. It may be beneficial to talk with a physical therapist to obtain a focused routine for strengthening those small but important muscle groups.

Furthermore, following safe lifting recommendations at work or home can help reduce the risk of injury.

Now let us take a closer look at the anatomy. The rotator cuff is made of four muscles and their corresponding tendons. Starting up at the front and working our way back, we have the subscapularis, supraspinatus, infraspinatus, and teres minor.

Each of these muscles originates on the scapula, called the shoulder blade, and then they travel to the upper arm bone or humerus, where their tendons attach. Here, the tendons form a cuff of tissue that works to stabilize and mobilize the shoulder joint. Out of the four rotator cuff tendons, the supraspinatus tendon is torn most often.

How do you know if you have a rotator cuff tear? Sometimes, patients will have a tear and not experience any symptoms. If symptoms are present, pain is common with both movement and at rest.

Often, patients will complain of pain trying to sleep on the affected shoulder or pain that wakes them up from sleep. Along with pain, weakness and decreased range of motion may also be reported.

When seeing a doctor for potential rotator cuff injury, they will perform a physical examination, including looking at both shoulders for signs of swelling, bruising, or deformity. They will feel the shoulders to see if there is pain. In addition, the doctor will evaluate the motion of both shoulders and test the strength of each individual rotator cuff muscle.

Along with a physical examination, the doctor will order imaging tests to confirm the diagnosis of rotator cuff tear when suspected. They will start with x-rays to evaluate the bones of the shoulder joint, looking for any broken bones if there was a traumatic injury, evidence of arthritis, or other bony changes.

Magnetic resonance imaging, referred to as MRI, is best for looking at soft-tissue structures and will be ordered to see if there is a rotator cuff tear.

When a rotator cuff tear has been identified, the doctor will inform the patient of their options nonoperatively and operatively, along with the risks and benefits of each, so they may decide on the next steps for treatment.