Whether you have experienced a traumatic tear or a gradual degeneration, an injury of the rotator cuff will reduce your shoulder mobility and present painful symptoms.
The more you understand, the less concern you will have about the recovery process, and you can be more confident and proactive. Well-informed patients are more likely to have successful treatment procedures and faster recoveries because they can anticipate the steps ahead and prepare accordingly. A rotator cuff injury will include lifestyle alterations, pain medication and extra precautions in shoulder usage.
What Is the Rotator Cuff?
Four tendons attach muscles from the shoulder blade and ribs to the upper arm bone (humerus). Because these tendons help to rotate the arm within its socket, this sleeve of tendons is called the rotator cuff. The rotator cuff muscles are connected individually to a group of flat tendons, which fuse together and surround the front, back and top of the shoulder joint like a cuff on a shirt. The tendons attach the muscles to the bone and allow movement in the shoulder, as well as providing strength to hold the ball in its socket.
The muscles in the rotator cuff are involved in all shoulder motions. When the muscles contract, they pull on the rotator cuff tendon causing the shoulder to rotate upward, inward or outward. The rotator cuff ligaments attach bone to bone and provide stability to the shoulder joint bones.
Between the bones, muscle and other soft tissue there are several bursae (fluid filled sacs) and synovial fluid (lubricates your joint), which permit smooth gliding between the joint. They also protect the rotator cuff from the bony parts of the shoulder blade.
What is a Rotator Cuff Tear?
A rotator cuff tear is a rip in the group of four muscles and tendons that stabilize your shoulder joint and let you lift and rotate your arms (your rotator cuff). It’s also called a complete tear or a full-thickness tear.
A rotator cuff tear is a common injury, especially in sports like baseball or tennis, or in jobs like painting or cleaning windows. It usually happens over time from normal wear and tear, or if you repeat the same arm motion over and over. But it also can happen suddenly if you fall on your arm or lift something heavy.
Types of a Rotator Cuff Tear
Types of torn rotator cuffs include:
- Partial: With an incomplete or partial tear, the tendon still somewhat attaches to the arm bone.
- Complete: With a full-thickness or complete tear, the tendon separates completely from the bone. There’s a hole or rip in the tendon.
Symptoms of a Torn Rotator Cuff
If you have suffered a traumatic sudden injury to your shoulder, you may have heard a sudden popping sound or felt a tearing sensation in your shoulder. Swelling around your shoulder will happen within a few hours after the injury or in the following days. If the injury is severe enough, you may also have some bruising on your shoulder. Immediate, intense, pain will follow – especially when you try to raise, lower, or rotate your arm.
If your rotator cuff tear is big enough you might feel weakness (instability) in your shoulder. Over time this weakness will turn into a limited range of motion and inability to raise, lower, or rotate your arm – resulting in pain. At this point your rotator cuff injury would also be interfering with your sleep, causing pain and night and forcing you to wake up several times to adjust your sleeping position.
Diagnosis
During the physical exam, your doctor will press on different parts of your shoulder and move your arm into different positions. He or she will also test the strength of the muscles around your shoulder and in your arms.
In some cases, they may recommend imaging tests, such as:
- X-rays. Although a rotator cuff tear will not show up on an X-ray, this test can rule in or out other potential causes for your pain — such as bone spurs or arthritis.
- Ultrasound. This type of test uses sound waves to produce images of structures within your body, particularly soft tissues such as muscles and tendons. It allows dynamic testing, assessing the structures of your shoulder as they move. It also allows a quick comparison between the affected shoulder and the healthy shoulder.
- Magnetic Resonance Imaging (MRI). This technology uses radio waves and a strong magnet. The images obtained display all structures of the shoulder in great detail. The quality of the images depends greatly on the quality of the equipment used.
Treatments
Your treatment for a rotator cuff injury will depend on the type of damage. For most rotator cuff injuries, doctors prescribe conservative treatment.
Nonsurgical Options
Conservative treatment includes:
- Rest
- Icing the area for 20 minutes at a time a few times a day
- Modifications of activities involving shoulder use
- Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, whether over-the-counter or prescription
- Exercises to stretch and strengthen the shoulder blade and other muscles
- Corticosteroid injections
Surgical treatment
If symptoms persist or worsen, your doctor may recommend surgery. Your doctor will also prescribe surgery for severe shoulder injuries. Recovery times from surgery vary depending on the type of surgery and extent of your injury. In some cases, healing can take up to 2 years, but most people are back to their normal activities and recover much sooner than that.
Discuss with your doctor which type of surgery is best for your particular injury. Options include:
- Open surgery. This is the most invasive. It may be needed for complex repairs.
- Arthroscopic surgery. A miniature camera guides your surgeon to do the repair. This requires only small incisions. It’s the most common type of surgery.
- Mini-open surgery. Your surgeon uses miniature instruments to do the repair. This requires only a small incision.
Preparing for Your Appointment
You will likely start by seeing your family doctor or sports medicine physician. If your injury is severe, you might be referred to an orthopedic surgeon. If you’ve been treated for a similar problem in the past, you may need to bring past records and imaging studies with you to your appointment.
Before the appointment, you might want to write a list that answers the following questions:
- When did you first begin experiencing shoulder pain?
- What movements and activities worsen your shoulder pain?
- Have you ever injured your shoulder?
- Have you experienced any symptoms in addition to shoulder pain?
- Does the pain travel down your arm below your elbow?
- Is the shoulder pain associated with any neck pain?
- Does your job or hobby aggravate your shoulder pain?
Ask Your Doctor
To learn more about rotator cuff tears, including your options for prevention and treatment, speaking with an orthopedic specialist is your best choice. Our skilled and experienced orthopedic surgeons will perform a thorough examination of your shoulder, analyze X-rays, and conduct physical tests.
To learn more about the procedure or to schedule an appointment with one of our rotator cuff repair specialists, call us at 800-698-1280.
