Rotator Cuff Tear

Anatomy

The rotator cuff is actually a group of four muscles that attach to the shoulder blade (scapula), and wrap around the front, back, and top of the shoulder joint. Together the rotator cuff muscles help guide the shoulder through many motions, and also lend stability to the joint. The ends of the rotator cuff muscles form tendons that attach to the arm bone (humerus).  Unfortunately, it is also a group of muscles that is frequently injured by tears, tendonitis, impingement, bursitis, and strains.  The major muscle that is usually involved is called the supraspinatus muscle or tendon. 

Cause of injury

A rotator cuff tear occurs when the rotator cuff gets worn so bad that it wears a hole through the rotator cuff tendon. Since the tendon is what connects the rotator cuff muscle to your humerus bone, when the tendon is torn, you have weakness in the shoulder. Usually these tears occur in people who have had shoulder pain for some time (called a "chronic rotator cuff tear"). This is, by far, the most common type of rotator cuff tear.  However, tears sometimes happen in people who do not have a history of shoulder problems. These people try to lift something that is too heavy and feel a pop in their shoulder, usually with immediate pain, this is called an acute rotator cuff tear.  A rotator cuff injury is seen both in the young and old. Usually in younger patients, there is either a traumatic injury, or the patient is demanding unusual use of their shoulder, as seen in professional athletes. As people age, the muscle and tendon tissue of the rotator cuff loses some elasticity, becomes more susceptible to injuries, and is often damaged while performing everyday activities. Therefore, a rotator cuff injury tends not to discriminate by age.  Not every rotator cuff injury causes significant pain or disability; in fact, autopsy studies have shown rotator cuff tears in up to 70% of people over the age of 80 and 30% of the population under the age of 70. However, in many individuals a rotator cuff injury can cause significant disability, and prompt diagnosis and treatment can have a profound improvement in symptoms.

Signs and Symptoms

Rotator cuff tears usually cause the following symptoms:

Pain - primarily on top and in the front of your shoulder. Sometimes you can have pain at the side of your shoulder. Usually is worse with any overhead activity (reaching up above the level of your shoulder).

Weakness - moderate to severe weakness, especially worse with overhead activity. This weakness is worse than in those people with simple rotator cuff tendonitis.  Often patients complain of inability to put dishes up in the cupboards. Some patients with tears cannot lift their arm up to do their hair or scratch their head.

Stiffness - many patients will experience stiffness in the shoulder. This happens because it either hurts to move the shoulder, or you simply cannot move it because you are too weak. This stiffness can be progressive - meaning that it can get worse with time. Sometimes, the stiffness and loss of motion alone can be the biggest problem!

Popping - sometimes bursitis that occurs with rotator cuff tears can cause a mild popping or crackling sensation in the shoulder. In addition, the tear itself may rub and can cause this sensation.

Unable to sleep on shoulder - most patients with tears of the rotator cuff complain of difficulty sleeping on the shoulder at night.