Shoulder rotator cuff tears are common injuries that affect the complex shoulder joint, making many daily activities difficult to perform due to pain and/or weakness. The rotator cuff consists of muscles and tendons surrounding the shoulder joint which keep the head, or ball, of the upper arm bone (humerus) in the socket of the shoulder blade. Because the rotator cuff enables the arm to rotate and lift, when it is injured, the patient’s range of motion can be greatly affected.
There are two types of rotator cuff tears:
- Partial or incomplete tear: The tendon is damaged but not completely severed.
- Full-thickness or complete tear: The tendon becomes separated from the bone completely.
Many rotator cuff injuries begin with the tendons fraying and gradually progress until a tear occurs when the shoulder experiences additional stress, such as lifting a heavy object.
What Causes Rotator Cuff Tears?
Rotator cuff tears can be caused by an acute injury, such as falling on an outstretched arm or heavy lifting involving a jerking motion. These acute types of rotator cuff injuries can also occur in conjunction with other shoulder injuries, such as shoulder dislocation (separation) or broken collarbone.
The most common cause of a rotator cuff tear is degeneration, or wear-and-tear. Usually affecting the dominant arm of the patient, degenerative tears progress slowly over time as we age.
Factors which can contribute to these chronic rotator cuff tears include:
- Repetitive motion involving the shoulder: Movements that repeatedly place stress on the rotator cuff can cause overuse tears. Many sporting/recreational activities and routine chores or jobs can be the cause of microtears that can ultimately result in a complete or partial rotator cuff tear.
- Bone spurs: Overgrowth of a bone can occur under the acromion bone and rub against the rotator cuff when the arm is lifted. This shoulder impingement weakens the tendons and may cause tears.
- Decrease in blood supply: As we get older, blood supply naturally decreases to the rotator cuff tendons. In this way, a damaged tendon is harder for the body to repair, making it more vulnerable to a tear.
- Genetics: People with a family history of rotator cuff problems can be more susceptible to tears.
Common repetitive motion activities that can contribute to rotator cuff tears include:
- Baseball/softball
- Tennis
- Weightlifting
- Rowing
- Carpentry work/painting
- Any activity involving excessive overhead work or lifting
Rotator cuff tears are most common in patients over 40 because of wear-and-tear over time.
Symptoms of a Rotator Cuff Tear
Pain is typically the most common symptom of a rotator cuff tear.
Pain may present:
- At the top of the shoulder or arm
- Descending down the outer arm to the elbow
- At rest, especially when lying on the affected shoulder
- When lifting or rotating the arm
- More frequently and intensely over time
Other symptoms can include:
- Weakness when lifting or rotating the arm
- Crackling sensation (crepitus) when the shoulder is in certain positions
- Difficulty performing daily reaching activities, such as brushing the hair and getting dressed
- Clicking or popping in the shoulder
Acute or sudden rotator cuff tears often cause intense pain and immediate weakness in the upper arm which may be accompanied by a snapping sensation. In these cases, it is recommended that you be evaluated as soon as possible by your orthopedic specialist.
Some rotator cuff injuries do not present with pain but may still cause weakness or other symptoms. Because of this, patients may be unaware that they even have an injury unless or until the rotator cuff tears completely.
Diagnosing a rotator cuff tear involves a physical examination by your orthopedic surgeon during which muscle strength and range of motion will be evaluated. Learn more about Diagnosing and Treating Rotator Cuff Tears .