The rotator cuff is a group of four muscles and tendons that surround the shoulder joint. These muscles help to stabilize the shoulder and allow for a wide range of motion. A rotator cuff tear is a painful injury occurring when one or more of these rotator cuff tendons or muscles are torn.

Rotator cuff tears are common, especially in people over the age of 40. Typically, the tear happens in the shoulder of the person’s dominant hand, but it can also occur in the opposite shoulder. These injuries can be caused by a number of events and risk factors, including the following:

• Age-related degeneration. In a degenerative tear, the tendons of the rotator cuff can weaken and tear over time. Degenerative tears can happen especially following a history of shoulder injuries.
• Overuse or repetitive strain. Activities that stress the shoulder, such as overhead sports or manual labor, can increase the risk of rotator cuff tears.
• Traumatic injury. A fall or other trauma can cause a sudden rotator cuff injury.
• Some people are more prone than others to develop rotator cuff tears due to their family medical histories.
• Bone spurs. A bone spur can narrow the space within the shoulder joint and irritate the rotator cuff tendons. When pinched by a bone spur, the rotator cuff tendons can become frayed.
• Other medical conditions. Certain medical conditions, including diabetes and rheumatoid arthritis, can weaken tendons and raise the risk of a rotator cuff tear.

Symptoms of a rotator cuff tear

The symptoms of a torn rotator cuff can vary depending on the size and location of the tear. Common symptoms include:

• New or chronic shoulder pain. The pain is often worse at night and when you try to lift your arm overhead.
• Shoulder or arm weakness. You may have difficulty reaching behind your back.
• Limited range of motion. You may find it hard to raise your arm above your head or to rotate your arm outward.
• Clicking or popping sounds in the shoulder. Some people with rotator cuff tears hear distinctive sounds when trying to move the injured shoulder.

Diagnosis of a torn rotator cuff

Your health care provider will likely start by asking about your medical history and symptoms before performing a physical examination of your shoulder. During the physical exam, the doctor will look for signs of inflammation and weakness in your shoulder area. You might also be asked to perform certain movements to test your range of motion.

If your doctor suspects that you have a rotator cuff tear, imaging tests may be ordered to confirm the diagnosis. This also helps to determine whether an injury is a partial tear or a complete tear, a type of rupture also known as a full thickness tear. Common imaging tests for rotator cuff tears include:

• X-ray, which can show damage to the shoulder or upper arm bone.
• Magnetic resonance imaging (MRI). This more detailed test can also display the soft tissues in the shoulder, including the rotator cuff.
• Ultrasound, which uses sound waves to produce images of the soft tissues.
• Arthroscopy: The provider inserts a small camera known as an arthroscope through a small incision in the shoulder. This enables internal photos of the affected area.

Treatment of a rotator cuff tear

The treatment for a rotator cuff tear will depend on the size, severity, and location of the tear. Your age and overall health will also be considered.

Nonsurgical treatment options

Nonsurgical treatment is often the preferred option for people with small rotator cuff tears. Common nonsurgical treatments include:

• Rest. It is important to rest your shoulder and avoid activities that put stress on it.
• Ice. Applying ice to your shoulder for 20 minutes at a time can help to reduce pain and inflammation.
• Over-the-counter (OTC) pain relievers such as ibuprofen or naproxen can also relieve pain and inflammation.
• Corticosteroid injections. These injections are a longer-lasting method of easing pain and inflammation, but they must be performed by a health practitioner.
• Physical therapy can help to strengthen the muscles around your shoulder and improve your range of motion.

Surgical treatment options

Treatment by an orthopedic surgeon may be necessary for large rotator cuff tears or tears that don’t respond to nonsurgical treatment. Orthopedic surgeons perform the following common types of surgical repair for rotator cuff tears:

• Arthroscopic surgery, the most common surgical treatment for a rotator cuff tear, is a minimally invasive procedure performed through small incisions. During arthroscopic surgery, the surgeon repairs the tear using stitches or anchors.
• Open surgery is a more invasive procedure, performed through a larger incision. During open surgery, the surgeon usually repairs the tear using stitches or anchors.

For tears that can’t be surgically repaired due to their size and/or age, a different type of operation may be necessary. Options include reverse shoulder replacement, tendon transfer, or a debridement of scar tissue without repair.

Recovery and rehabilitation

The recovery time from a rotator cuff tear can vary. It’ll depend upon the size, severity, and location of the tear, as well as the type of treatment. Most people will need to wear a sling for several weeks after surgery. Physical therapy, an important part of the recovery process, can help to strengthen the muscles around the shoulder and improve range of motion. Patients with severe rotator cuff injuries can experience a year or more of recovery time.

Rotator cuff tears are common and can usually be treated effectively. If you have pain or weakness in your shoulder, it is important to see a doctor for a diagnosis and treatment plan as soon as possible. Early diagnosis and treatment can help patients to regain full functionality more quickly.

Get to know Dr. Casey Gaskins

Roger “Casey” Gaskins, III, MD is a Florida-based Board Certified Orthopedic Surgeon and Upper Extremity Specialist. He received his medical doctorate from the University of Florida where he graduated with Honors then completed his Orthopedic Surgery Residency at the University of South Florida.

Dr. Gaskins treats patients of all ages and addresses concerns ranging from athletic injuries to chronic arthritis. He specializes in hand surgery and in minimally invasive and contemporary open surgeries of the upper extremity, from the fingertip to the shoulder.

Dr. Gaskins follows an individualized approach to maximize your function, minimize your pain and get you back to your life. Whether your treatment plan is conservative or surgical, Dr. Gaskins and his team will provide you with the best care possible.