Rotator Cuff Tear

Description

A rotator cuff tear is characterized by pain and weakness in the shoulder as a result of tearing the rotator cuff tendons, and it is often associated with inflammation of the subacromial bursa. The rotator cuff is a series of four muscles that surround the ball of the shoulder (humeral head), and these attach to bone via tendons. The muscles attach to the shoulder blade on one side and to the humeral head on the other. The main function of the rotator cuff is to maintain the humeral head in the center of the socket, and it is important in keeping the humeral head in the socket when initiating shoulder motion, such as to reach overhead or perform any activity that requires shoulder strength. The rotator cuff is also important in maintaining shoulder stability and in guiding shoulder motion.

Common signs and symptoms

• Pain around the shoulder, often at the outer portion of the upper arm

• Pain that is worse with shoulder function, especially when reaching overhead or lifting

• Aching when not using your arm

• Pain that often awakens you at night, especially when sleeping on the affected side

• Tenderness, swelling, warmth, or redness over the outer aspect of the shoulder (occasionally)

• Loss of strength

• Limited motion of the shoulder, especially reaching behind you to a back pocket or bra or reaching across your body

• Crepitation (crackling sounds) when moving the shoulder

• Biceps tendon pain and inflammation in the front of the shoulder

• Pain that worsens with bending the elbow or lifting

Causes

• Strain from a sudden increase in the amount or intensity of activity

• A direct blow or injury to the shoulder

• Aging and degeneration of the tendon with normal use

• Acromial spur, a bony growth at the roof of the shoulder

Factors that increase risk

• Contact sports such as football, wrestling, and boxing

• Throwing sports such as baseball, tennis, or volleyball

• Weight lifting and bodybuilding

• Heavy labor

• Previous injury to the rotator cuff, including impingement

• Poor physical conditioning (strength, flexibility)

• Inadequate warm-up before practice or play

• Inadequate protective equipment

• Increasing age

• Spurring of the acromion

• Repeated cortisone injections

Preventive measures

• Appropriately warm up and stretch before practice and competition.

• Allow time for adequate rest and recovery between practices and competition.

• Maintain appropriate conditioning that includes cardiovascular fitness, shoulder flexibility, and strength and endurance training of the rotator cuff muscles and muscles surrounding the shoulder blade.

• Use proper sports technique.

Expected outcome

Symptoms may resolve spontaneously; however, rotator cuff tears do not heal on their own. Surgery is often needed to optimize shoulder strength and alleviate pain.

Possible complications

• Persistent pain during activity that may progress to constant pain, even at rest

• Shoulder stiffness, frozen shoulder, or loss of motion

• Persistent weakness

• Recurrence of symptoms, especially if treated without surgery

• Inability to return to the same level of sports performance, even with surgery

• Risks of surgery, including infection, bleeding, injury to nerves, shoulder stiffness, weakness, retearing of the rotator cuff tendon, deltoid detachment, acromial fracture, excessive removal of acromion, and persistent pain

General treatment considerations

Initial treatment consists of medication and ice to relieve pain along with stretching and strengthening exercises and modification of the activity that initially caused the problem. These all can be carried out at home, although referral to a physical therapist or athletic trainer may be recommended. An injection of cortisone to the area around the tendon within the bursa may also be an option. In athletes, surgery is usually recommended to remove the chronically scarred bursa and spur from the acromion and repair the tendon by attaching it to itself or to the bone. Surgery may be performed arthroscopically or with an open incision, and a return to full activity after surgery usually requires 6 to 12 months of recovery time.

Medication

• Nonsteroidal antiinflammatory medications, such as aspirin and ibuprofen (do not take for 7 days before surgery), or other over-the-counter pain relievers, such as acetaminophen, are often recommended. Take these as directed by your physician, and contact your doctor immediately if any bleeding, stomach upset, or signs of an allergic reaction occur.

• Pain relievers are usually not prescribed for this condition. If your physician does prescribe pain medications, use them only as directed.

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