A rotator cuff tear is a rotator cuff injury that can cause shoulder pain and loss of arm function. The rotator cuff is a set of muscles and tendons in your shoulder. They enable you to lift and move your arms away from your body. It holds the ball of your upper arm bone (humerus) in the shoulder blade socket. It resembles a golf ball lying on a golf tee. Rotator cuff tears happen when the tendons move away from the arm bone. A tear could be the result of overuse or another type of injury.

Types of rotator cuff tears

Torn rotator cuffs are classified into the following types:

• Partial: With an incomplete or partial tear, your tendon remains somewhat attached to your arm bone.
• Complete: Your tendon has a hole or rips in it, and it separates from your bone entirely when it is full-thickness or completely torn.

Symptoms

The following are signs of a rotator cuff tear:

• Difficulty, pain, and weakness from raising, lowering, or rotating your arm.
• You may experience popping, clicking, or crackling sounds or sensations when you move your arm in specific ways.
• Shoulder pain that worsens at night or while resting the arm.
• Shoulder weakness causes difficulty lifting items.

Causes

A fall can result in a broken collarbone or a dislocated shoulder, which damages your rotator cuff. Rotator cuff tears are more common and occur over time when your tendon breaks down from age and use (degenerative tear). People over the age of 40 are most at danger. The causes of degenerative tears are:

• Bone spurs: Bony growths may arise on the top of your shoulder bone. When you elevate your arm, these bone spurs rub against the tendon. This shoulder impingement causes friction between the bone and the tendon. A partial or complete tear may develop over time.
• Decreased blood flow: Blood flow to the rotator cuff declines with age. Your muscles and tendons require adequate blood circulation to repair themselves, and tendons can tear if they do not receive enough blood supply.
• Overuse: Repetitive shoulder movements in sports or on the job can strain your muscles and tendons, resulting in a tear.

Risk factors

Anyone can experience a rotator cuff tear. These factors may increase your risk:

• Biological family history of shoulder issues or rotator cuff injuries.
• Poor posture.
• Smoking.
• Being 40 years old or older.

Diagnosis and Tests

Your healthcare provider will conduct a physical examination to assess shoulder discomfort, range of motion, and arm strength. To confirm a diagnosis, you may receive:

• An X-ray to diagnose arthritis or bone spurs.
• An MRI (magnetic resonance imaging) or ultrasound is used to look for tendon tears.

Treatment

Nonsurgical and surgical options may be available for treating rotator cuff tears.

• Nonsurgical options: Rotator cuff injuries can not heal on their own without surgery, but many patients can improve function and reduce pain with nonsurgical treatment that strengthens their shoulder muscles. Just because you have a tear does not indicate you require surgery; many people have rotator cuff injuries without even realizing it. Nonsurgical treatments improve the condition of around 8 out of every 10 persons with partial tears. It may take up to a year for the situation to improve.

Nonsurgical treatments include the following:

• An arm sling and rest will allow your shoulder to heal. You may need to modify your activities and discontinue certain work or sports for some time.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) are used to relieve pain and swelling.
• Physical therapy can help you learn strengthening and stretching exercises.
• Steroid injections relieve pain and swelling.

Surgical options

If you have a complete tear or if nonsurgical therapies are ineffective, your healthcare practitioner may prescribe surgery. If your profession or sporting pursuits cause problems with your shoulder, you may need surgery. Most rotator cuff procedures are performed arthroscopically using small cuts (incisions). When necessary, the surgeon will do an open procedure. The surgery is performed as an outpatient procedure. You can go home the same day, although the entire recuperation time for this surgery can be a year or longer.

During the surgery, your healthcare provider:

• An arthroscope (small camera) is inserted into your shoulder through a small incision.
• Refers to images obtained through the arthroscope during the procedure.
• To remove bone spurs and reconnect your tendon to your upper arm bone, tiny instruments will be inserted into small incisions in your shoulder.
• A partial tear may require your healthcare professional to trim fraying parts of the tendon. This debridement technique prevents the shoulder ball and socket from snagging on your tendon and damaging it further. Some tears cannot be repaired because of their size or age. For these types of rips, you may require a reverse shoulder replacement, tendon transfer, or scar tissue debridement without healing.

Prevention

To avoid a symptomatic rotator cuff injury, keep your muscles and tendons flexible. Your healthcare practitioner can teach you home stretching and strengthening activities.

If not corrected, rotator cuff tears can severely impact everyday activities and quality of life. Early diagnosis and treatment are critical for avoiding long-term problems and recovering shoulder function. Whether treated conservatively or surgically, a comprehensive rehabilitation plan and preventive measures can help assure a full recovery and lower the risk of recurrent injuries.