Rotator Cuff Tears
Shoulder rotator cuff tear is a common cause of pain in adults, resulting in a weakened shoulder which limits daily activities. When one or more of the rotator cuff tendons is torn, the tendon no longer attaches itself to the humerus (upper arm bone). These torn tendons begin by fraying and can completely tear as the damage progresses.
There are different types of tears:
- Partial tear – an incomplete tear where the damaged tendons are not completely severed.
- Full-thickness tear – also known as a complete tear, separating all of the tendons from the bone, resulting in a hole in the tendon.
Signs and Symptoms
Shoulder rotator cuff tears can happen suddenly, causing intense pain. There may be a snapping sensation, with immediate upper arm weakness.
Tears could also develop slowly, with noticeable pain in the shoulder when you lift your arm, or pain that moves down the arm. Pain might be mild at first and over-the-counter medications may help. However, the pain can become more intense over time, affecting sleep, especially when lying on the affected side, and causing weakness in the shoulder that makes it difficult to complete daily activities.
Some rotator cuff tears are not painful but can still result in arm weakness.
Causes and Risk Factors
The rotator cuff consists of a complex of four muscles surrounding the shoulder joint, which is responsible for stabilising the shoulder and contribute to active arm movements.
Rotator cuff tears are caused by two main factors: injury and degeneration.
Sudden injuries such as falling on your outstretched arm or lifting something too heavy can tear off your rotator cuff. This can also occur with other injuries such as a broken collarbone or dislocated shoulder.
Degeneration occurs naturally as we age, and rotator cuff tears can arise from wear and tear. Some factors that contribute to degenerative rotator cuff tears include:
- Repetitive stress – repeating the same shoulder movements, putting stress on your rotator cuff muscles and tendons.
- Lack of blood supply – blood supply to our rotator cuff tendons decrease as we age, impeding the body’s natural ability to repair damaged tendons, leading to tears.
- Bone spurs – bony overgrowth which rubs on the rotator cuff tendon when lifting the arm, weakening the tendon, and resulting in tears.
Your orthopaedic specialist will start off with a physical examination of your shoulder to check for tenderness and deformity. You may be asked to move your arm in different directions to measure its range of motion and to test your arm strength. Your orthopaedic specialist may also check your neck to rule out a “pinched nerve” and other conditions like arthritis.
Your orthopaedic specialist may also use imaging tests to help determine if you have rotator cuff tears:
- X-rays – may show a bone spur or calcifications in the tendon, commonly associated with rotator cuff tears, or to rule out gross shoulder arthritis.
- MRI scans – can better show soft tissues like the rotator cuff tendons and gives valuable information regarding where the tear is located, the number of tendons involved, the amount of retraction and fatty atrophy in the muscle following a tendon tear. MRI also helps to evaluate for associated degenerative tears in the long head of biceps attachment (SLAP tears) and evaluate the cartilage in the shoulder joint
The treatment for rotator cuff tears is dependent on the severity of your condition and the symptoms you experience. Ultimately, the main goal of treatment is to help you relieve pain, allow you to resume your usual activities and prevent permanent injury to your shoulder.
Your orthopaedic specialist may recommend non-surgical treatments such as rest and avoiding lifting activities that cause shoulder pain. Pain relievers or anti-inflammatory medications may help to reduce shoulder pain and inflammation. Physical therapy can help to strengthen the remaining muscles and maintain joint movement.
Injections can include steroids to reduce inflammation and provide temporary pain relief, or platelet rich plasma injections to promote healing in partial tendon tears.
If conservative treatments prove to be ineffective, your orthopaedic specialist may recommend surgery. This could be a good option if your symptoms have lasted beyond 3 months, you are experiencing significant weakness and loss of function in your shoulder, or you have a full thickness or large tear that is unlikely to heal well. Early treatment is the key to successful outcomes. Surgery usually involves arthroscopic (keyhole) rotator cuff repair to reattach the torn tendon back to the head of the humerus. However, for large, chronic tears in elderly patients who present late with arthritis of the shoulder, a modified form of shoulder replacement, known as the reverse shoulder arthroplasty, can effectively reduce pain and restore shoulder function.
Every case is different; hence it is best to consult an orthopaedic surgeon for an accurate diagnosis so that you can obtain the best treatment option that is most suitable for you. Dr Poh and his team is experienced in the full range of treatments available for rotator cuff tears, and will optimise the appropriate treatment for you to achieve the best outcomes. Reach out to us today if you suspect that you are suffering from rotator cuff tears and let us help you enjoy a better quality of life.