What is a Rotator Cuff Tear?

Rotator cuff tearexplained by Denver, Golden, Aurora, Boulder, Broomfield, Jefferson, and Littleton Colorado’s top pain doctors

Rotator Cuff DiagramTears involving the rotator cuff are relatively common. These types of injuries can result in significant shoulder pain. This pain is believed to be the result of irritation and injury to the tendons and muscles that are located within the rotator cuff. However, rotator cuff tears may also be the result of another medical condition. Though some individuals may be considered more at risk for developing a rotator cuff injury, shoulder pain can be experienced by individuals of any age. Further, specific symptoms of pain can vary widely from individual to individual.

Made of a complex network of tendons, muscles, and bone, the shoulder consists of many components that can be the source of injury and pain. The shoulder joint specifically is comprised of the humerus, clavicle, and scapula bones, along with the teres minor, supraspinatus, subscapularia, and infrasphinatus muscles; all of which are susceptible to injury.

In general, patients with a rotator cuff injury report symptoms of tenderness, shoulder weakness, pain, discomfort, and restricted range of motion within the shoulder. This pain can range from dull and mild to severe, and may even begin to radiate down the arm. The onset may be acute or gradual. Patients with a rotator cuff injury are likely to experience pain that worsens when attempting to do things overhead, such as lifting, reaching behind the back, or pulling. They may also experience worsening pain when lying on the affected shoulder. In many cases of rotator cuff tears, the patient will describe a crackling, clicking, or even popping sound when they attempt to move their shoulder.

In order to achieve a proper diagnosis, patients must undergo a physical examination, including a detailed assessment of the degree of pain and swelling. This assessment will also include a detailed personal history as well as a detailed account of the current episode of shoulder pain.

Causes of Rotator Cuff Tears

Rotator Cuff Tear MRIIn many instances, a rotator cuff tear is caused by excessive strain placed on the rotator cuff joint. Over time, this ongoing and excessive strain or stretching can cause small tears along the ligament leading to inflammation and significant pain. Many patients with a rotator cuff injury report that their pain began suddenly following a particular event; however, others have described that their symptoms occurred much more gradually, with the pain increasing over time. The most common causes of injury to the rotator cuff are related to engaging in sports or other activities that involve overhead movements. Common sports-related rotator cuff tears occur in tennis or racquetball players.

Other factors that are known to increase the risk for a rotator cuff tear are being male, increasing age, and history of shoulder trauma or injury. These injuries are also more likely to occur in the patient’s dominant arm.

Treatment for Rotator Cuff Tears

For patients experiencing mild and non-severe pain, it is generally recommended that conservative first-line treatments are attempted to initially control the patient’s symptoms of pain. Many interventions are available that can be conducted at home and can provide significant relief for rotator cuff tear pain. For instance, it may be recommended that patients with a rotator cuff tear first attempt to rest following the injury in order to allow the tissue to heal properly. Patients may also use a cold compress to help reduce the swelling in the area of the rotator cuff injury. This can be applied twice a day for ten to 15 minutes. Physical therapy can also be highly effective. This program will involve several specified stretches and other exercises that target the injured rotator cuff.

Cervical Epidural Steroid InjectionOver-the-counter pain relievers with anti-inflammatory qualities (NSAIDs, such as ibuprofen or naproxen) can be very beneficial for patients with a rotator cuff injury. These medications are believed to be effective because of their anti-inflammatory characteristics. Other medications, such as oral corticosteroids like prednisone and cortisone, may be recommended in instances where the patient’s pain was not significantly reduced using an over-the-counter pain reliever.

Rotator cuff tears can be associated with chronic or severe shoulder pain that causes significant interference with a patient’s ability to perform necessary daily functions. Patients with these more significant symptoms may wish to try interventional methods for managing their refractory pain. For instance, highly effective and almost immediate options for managing the pain associated with injury to the rotator cuff are steroid injections, such as cervical epidural steroid injections. These procedures involve the injection of an anaesthetic medication into affected area, such as the cervical joint, in order to intervene on the transmission of pain signals from the affected area to the brain. This procedure does involve some risk, as previous studies have shown that steroid injections may be linked with an increased risk for future rotator cuff injuries. Patients are encouraged to speak with their doctor regarding their degree of risk.

For rotator cuff tear pain that has not responded to other treatment attempts, surgery may be the only option.

Conclusion

Rotator cuff tears are a relatively common condition affecting the shoulder. The condition itself arises from injury and swelling in the rotator cuff joint located within the shoulder. Generally, patients describe the pain associated with rotator cuff tears to have occurred during a particular event, however, it is likely that the rotator cuff had begun to weaken and degenerate well before the reported onset of the injury. While there are some known genetic risks, in general, individuals who are involved in frequent physical activities are more at risk for developing a rotator cuff injury. In particular, individuals who play tennis regularly are at risk for a rotator cuff tear.

There are several treatment options available for assisting patients with managing their pain associated with a rotator cuff tear. Patients should speak with their doctor about their specific condition and to learn about the treatment options available for managing their pain.

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