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Rotator Cuff Tears

What is the rotator cuff?

The rotator cuff is a group of four muscles and tendons that surround the shoulder joint, keeping the head of the upper arm bone firmly within the shallow socket of the shoulder. These muscles and tendons provide stability to the joint and enable a wide range of shoulder movements.

A rotator cuff tear is a tear in one or more of the tendons of the four rotator cuff muscles in the shoulder. A partial tear affects only part of the tendon and does not completely detach from the upper arm bone. A complete tear is where the tendon is completely detached from the head of the upper arm bone. Many tears begin in fraying tendons that progress into complete tears.

Rotator cuff tears are relatively common, especially among certain populations. There is also a genetic component.

  • Repetitive overhead motions in certain sports (e.g., baseball, tennis) or occupations (e.g., painting, carpentry) are a common cause of a rotator cuff tear.
  • Degenerative tears occur from normal wear and tear, and typically occur in the dominant arm. Risk of a degenerative tear increases with age.
  • Acute trauma can lead to a rotator cuff tear in various ways. Sudden and forceful actions or accidents can place undue stress on the rotator cuff tendons, leading to partial or complete tears. Common causes of acute trauma include:
    • Falling on an outstretched arm or directly on the shoulder can cause significant damage to the rotator cuff tendons.
    • Lifting something too heavy, especially without proper technique or preparation, can lead to acute tearing in the tendons.
    • The sudden impact of a car accident, especially if the shoulder strikes an object like a door or window, can result in a tear.
    • High-impact or collision sports, or sports requiring repetitive overhead motions like baseball, basketball, or tennis, can cause acute tears. An awkward throw or a hard hit can lead to immediate injury.
    • Shoulder dislocation can cause a rotator cuff tear.
    • If the arm is pulled with great force, such as in trying to catch a heavy falling object or being yanked suddenly, the rotator cuff may tear.
    • Any sudden and forceful movement that puts unexpected stress on the shoulder, especially if the muscles are cold and not properly warmed up, can cause acute trauma to the rotator cuff.

Common symptoms include:

  • Pain when lifting the arm or lying on the affected shoulder. Pain may be sharp or a dull ache.
  • Weakness lifting or rotating the arm.
  • Reduced range of motion
  • Crepitus or a crackling sensation when moving the shoulder
  • Swelling and inflammation
  • Night pain
  • Difficulty performing daily activities like hair brushing or putting on a jacket

Dr. Reynolds will review your medical history, inquire about any shoulder injuries and your symptoms and perform an orthopedic examination of the injured shoulder. He will palpate for tenderness and swelling, and test range of motion and strength. He will look for other possible causes of pain including a pinched nerve or arthritis.

X-rays may show bone spurs, fractures or other causes of shoulder pain. An MRI will show soft tissue damage, and reveal the tear, its location and the size, and can also show how old or new the tear is, and the quality of the cuff muscles.

With the information he receives from the physical exam and imaging, Dr. Reynolds will make a diagnosis and discuss your treatment options with you.

Nonsurgical conservative treatment can improve pain and function in about 50% of patients but requires limiting activities.  Nonsurgical management is valuable because it avoids surgery, infection, permanent stiffness, anesthesia complications, and a lengthy recovery.

However, shoulder strength will not improve without surgery and tear size may increase.

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