A rotator cuff tear or injury is a serious condition. If the injury is severe, and complete tearing occurs to the muscle and/or tendon, you may require surgery. Many people who have a rotator cuff tear suffer chronic shoulder pain after the injury.
How common is a rotator cuff tear?
According to recent clinical studies, rotator cuff tears occur in 10-20% of the general population. Risks factors include advancing age, male gender, history of trauma, and engaging in heavy labor.
What causes a rotator cuff tear?
An acute injury often causes a rotator cuff tear, but this injury may be related to chronic wear-and-tear of the tendons and muscles. In front of the scapula (shoulder bone) is the acromion tendon, and impingement of this structure can lead to cuff tears in persons 40 years of age and older.
How does a rotator cuff tear feel?
Usually, you feel pain in the front aspect of the shoulder, and this pain shoots down the side of the arm. Pain may occur with overhead activities, such as reaching or lifting. Many patients report pain when sleeping on the affected side. You may also have weakness on the affected side, with difficulties raising the arm.
Should I keep using a painful shoulder?
A rotator cuff tear can get larger with time, so you need to see the doctor when shoulder pain first occurs. It is common for people with rotator cuff tears to report pain and weakness after the injury, but continue using the extremity. With worsening pain and decreasing strength, the tear often increases in size.
When should you see the doctor?
Early diagnosis and treatment for a rotator cuff injury could prevent serious complications, such as loss of motion and strength. When you see the doctor, he will take a medical history, inquire about your signs and symptoms, ask questions about your injury, and conduct a physical examination. In addition, the doctor will take x-rays and order a magnetic resonance imaging (MRI) scan to confirm the severity and grade of the rotator cuff tear.
How is a rotator cuff tear treated?
If surgery is not required, or if pain persists after surgery, several treatment options are used for a rotator cuff tear. These include:
- Medications – First-line therapy involves nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen and ibuprofen. For severe pain, narcotic analgesics are given short-term.
- Shoulder injection – The doctor may recommend a corticosteroid injection into the shoulder joint. This is not a recurring procedure, but it is often used initially or when severe inflammation occurs.
- Physical therapy – The therapist works with you to learn strengthening and flexibility exercises. Pain relief measures include ultrasound, electrical stimulation, heat packs, and cold therapy.
- Suprascapular nerve block – This involves injecting a long-acting anesthetic agent near the target nerve. This procedure takes around 20 minutes, and last for 1-3 months.
What are the surgical options?
If the rotator cuff tear is serious, or if the pain persists, the doctor may recommend an arthroscopic rotator cuff repair. This involves insertion of an arthroscope (tiny camera) and surgical tools through incisions around the shoulder joint. The torn tendon is grafted and re-attached to the bone. Arthroscopic tendon repair restores the normal anatomy and is a quick, simple procedure. Open tendon repair may be required. This involves a larger incision and a longer recovery time.
Resources
Yamamoto A, Takagishi K, Osaawa T et al. (2010). Prevalence and risk factors of a rotator cuff tear in the general population. Journal of Shoulder and Elbow Surgery, 19(1), 16-120.
