According to the American Academy of Orthopaedic Surgeons, an estimated 2 million people in the United States will visit a doctor for a rotator cuff problem each year.
The rotator cuff is four muscles connected by tendons to the humerus, or upper portion of the shoulder.
When a rotator cuff tear occurs, one or more of the tendons detaches from the humerus. The tear may be complete or partial and can cause significant pain and restrict movement.
Both surgical and nonsurgical treatments are available when a person tears their rotator cuff.
Rotator cuff injury causes tend to fall in one of two categories — an acute injury or chronic degeneration.
Injury or degeneration of the tendons can cause a torn rotator cuff.
A person can tear their rotator cuff performing a variety of activities. Examples of these types of injuries include:
- trauma, such as breaking a collarbone or dislocating a shoulder
- falling onto an outstretched arm
- lifting something in a sudden, jerking motion
- lifting something that is too heavy
These are just some of the common activities that can cause a rotator cuff tear.
A person’s tendons naturally wear down as they age. This degeneration is especially true for a person’s dominant arm.
Some of the potential contributors to chronic degeneration include:
- Affected blood supply: Blood supply to the tendons lessens with age, which increases the risk of tearing a rotator cuff. This means injuries are more common after 40 years of age.
- Bone spurs: Bone spurs are overgrowths of bone that can occur from repetitive movements. A person may notice that the pain worsens when they lift their arm if the bone spur presses on the rotator cuff.
- Repetitive movements: Athletes and people who work with their hands are prone to rotator cuff injuries. Examples of activities that increase the risk include baseball, rowing, and weightlifting. Common occupations where a person is prone to a rotator cuff tear include carpentry and decorating.
Rotator cuff tears may not immediately cause pain, although they can in acute injuries. Sometimes, a person may hear a distinct snapping sound with weakness in the upper arm afterward.
Other symptoms doctors associate with a rotator cuff tear include:
- popping sensations when a person moves their arm
- cracking sensations, known as crepitus, when moving the shoulder
- pain in the shoulder even at rest
- pain when lifting the arm or when throwing overhead
- shoulder locking into place
- weakness in the arm and hand
Sometimes, rotator cuff injury symptoms occur not only from the injury itself but also due to inflammation.
This inflammation is typically in the protective bursa sacs in the rotator cuff. Doctors call this condition bursitis.
A doctor may recommend an MRI to diagnose a torn rotator cuff.
A doctor will ask about a person’s symptoms, how the injury occurred, and if anything makes the pain better or worse.
They will also do a physical examination to determine a person’s range of motion and listen for any cracking or popping when they move their shoulder.
A doctor can also arrange imaging studies of the arm and shoulder, such as:
- X-ray: This type of imaging will look for signs of bone calcifications, arthritis, or other injuries.
- Magnetic resonance imaging (MRI): This method of imaging uses a magnetic field to generate images of soft tissue. A doctor can identify areas of inflammation and potential tearing.
Depending on the nature of the injury, a doctor may perform other tests to determine if the rotator cuff is torn or if symptoms are due to another problem.
The treatment for a rotator cuff repair often depends on the tear’s severity, and how much it is affecting the individual.
A doctor will usually recommend conservative methods over surgical treatment whenever possible.
Examples of conservative treatments for rotator cuff injuries include:
- Rest: Resting the affected shoulder and wearing a sling for a few days following the injury can help reduce inflammation and pain. A doctor may also recommend avoiding certain activities to reduce strain on the shoulder.
- Physical and occupational therapy: Therapy exercises to stretch and strengthen the muscles around the shoulder can help reduce the demands on the injured rotator cuff.
- Over-the-counter medications: Medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) can help relieve pain. Examples of these include ibuprofen and naproxen sodium.
- Injections: A doctor may recommend corticosteroid injections into the shoulder to reduce inflammation and improve mobility.
It is possible for a rotator cuff tear to worsen or persist over time, even with at-home treatments.
If the rotator cuff does not heal with conservative methods, a doctor may recommend surgical treatment. Surgery may also be necessary for a tear greater than 3 centimeters.
A doctor will discuss the likelihood of the repair being successful, and the range of motion a person can expect after the surgery.
A 2015 meta-analysis covered studies on rotator cuff surgery versus conservative treatment. The evidence from this investigation suggests that surgery is not necessarily more effective than conservative treatments.
The authors concluded that more research is necessary, although current evidence does not suggest surgery is a guaranteed success for rotator cuff tears.
The surgical approach to a rotator cuff tear depends upon the tear’s severity and position. Sometimes, a surgeon will treat it by reattaching the tendon to its original attachment point.
Another approach involves trimming the injured tendon or smoothing the affected area. A doctor can do this by inserting small instruments into the shoulder and using other special tools to manipulate and repair the tendon.
Other surgical approaches include an open repair where a surgeon makes a larger incision.
A person should discuss the risks and benefits of surgery with a doctor.
After surgery, the recovery process often requires physical therapy or occupational therapy to restore the full range of motion in the shoulder.
Shoulder movement may return to normal in 4 to 6 months after the surgery.
As with any surgical procedure, there are risks the surgery will be ineffective, or symptoms will worsen. A surgeon will discuss these risks with a person who has a rotator cuff injury.
Examples of potential postsurgical complications include:
- detachment of the deltoid muscle at the shoulder, which can affect mobility
- injury to surrounding nerves
- shoulder stiffness and pain with movement
- surgical site infection
A person can also reinjure a repaired rotator cuff tendon at a later time.
According to the authors of a 2015 meta-analysis, most recreational athletes can return to the same level of play they were at before their injury occurred. However, among professional and competitive athletes, the study found only 50 percent returned to their same competitive level after their surgery.
A rotator cuff tear can significantly impair shoulder and arm movements. While conservative methods can treat most injuries, some people may require surgery to reduce pain and improve their range of motion.
If a person thinks they may have injured their rotator cuff or their injury seems to be getting worse, it is best to speak to a doctor.
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