What is Rotator Cuff Tears
Rotator cuff tears are a common condition affecting the shoulder. Pain in the shoulder can be the result of an injury, such as tears in the tendons or muscles, or as a secondary condition of another medical problem. Complaints of shoulder pain are not unique to any age group and specific clusters of pain symptoms can vary from individual to individual. The shoulder is a complex joint made up of numerous bones, tendons, and muscles, all of which may serve as the source for shoulder pain. More specifically, the clavicle, humerus, and scapula are the bones that make up the shoulder joint. The muscles found within the rotator cuff include the supraspinatus, subscapularia, teres minor, and the infrasphinatus. In general, shoulder pain is linked with injury to either the muscles or tendons within the rotator cuff.
Symptoms of rotator cuff injury typically include pain, tenderness, shoulder weakness, and restricted range of motion. The pain associated with rotator cuff injury can range from mild to severe, and may have a gradual or a sudden onset. Patients are likely to experience more pain when doing things such as reaching overhead, reaching behind the back, lifting, pulling, or lying on the affected shoulder. This pain can also radiate down the arm. In some cases, patients with rotator cuff tears have complained of clicking, cracking, or even popping sounds when they move their shoulder.
Physical examination includes assessment of pain and degree of swelling. Your physician will likely have a number of questions regarding your history, the onset of the current episode of rotator cuff pain, and a detailed description of the symptoms. Your physician may also palpate the shoulder, which may exhibit an audible cracking.
Causes for Rotator Cuff Tears
Rotator cuff injuries can often be described as having a sudden onset; however, evidence is suggestive of a more gradual development of complications. Overuse is the most common cause of difficulties. Athletes involved in activities that require overhead movements, such as tennis or racquetball, are at increased risk for developing difficulties with the rotator cuff.
Overload on the tendons within the rotator cuff leads to a non-inflammatory thickening of the tendon and an increase in tendon stiffness. Over time, if the overuse and overload of the tendon continues, the tendon will begin to become stressed leading to a disorganization of tendon tissue. Finally, ongoing stress and overload to the rotator cuff tendons eventually leads to degeneration of the tendon, which characterizes tendinitis. Bursitis is also a common type of irritation within the shoulder, which is characterized by irritation and inflammation to the bursa (fluid-filled sacs found in the shoulder joints that aid in movement).
Rotator cuff tears may affect anyone; however, individuals with higher activity levels are more at risk. In particular, individuals who frequently engage in activities that involve overhead activities characterize the population most at risk. Patients with chronic rotator cuff strain are at risk for more serious complications. More specifically, recurring degeneration and disorganization of the rotator cuff tendons can lead to small tears that may not heal completely, causing the tendon to be weak and more susceptible to additional and more serious injuries.
While overuse is a common cause of rotator cuff pain, some other factors have also been identified as placing an individual at greater risk for tendinitis. These factors include increasing age, being a male, and a history of shoulder injury or trauma. Rotator cuff injuries are more likely to occur in the dominant arm.
Treatment for Rotator Cuff Tears
Patients who present with more mild cases of rotator cuff injury may successfully treat their condition with conservative interventions. Your physician may recommend rest, specified physical therapy exercises (such as stretches), and over-the-counter pain relievers that also are effective for reducing inflammation (NSAIDs; nonsteroidal anti-inflammatory drugs). Oral corticosteroids, such as prednisone and cortisone, may also be recommended to reduce pain and inflammation of the affected area. Patients who are regularly involved in sports or exercise routines are strongly encouraged to allow ample time for full recovery. Full recovery may not be achieved for several weeks or even months. Though the patient may no longer be debilitated by symptoms of pain, stiffness, or weakness, the tendons within the shoulder may still not be fully healed.
Patients who are chronically debilitated by pain associated with rotator cuff tendinitis may be considered for steroid injections, such as cervical epidural steroid injections. Patients are encouraged to discuss this treatment option in depth with their physician, as receiving injections has been found to increase the patient’s risk of future tendon rupture
Surgical intervention is a final option for cases that have not responded to other therapeutic techniques.