A rotator cuff tear is a common shoulder injury that can be very painful and make it hard to move your arm. The orthopedic shoulder experts at The Ohio State University Wexner Medical Center in Columbus, Ohio, are here to help. We can diagnose and treat your rotator cuff tear using the latest treatments. Our goal is to reduce your pain and help you get back to the activities you love, whether it's playing sports, working out or just doing everyday tasks. We'll work with you to get your shoulder feeling better.
What is a rotator cuff injury?
Your shoulder is a “ball-and-socket” joint made up of muscle, other soft tissue and bone. The shoulder has three bones in it including the upper arm bone (humerus), the shoulder blade (scapula) and the collarbone (clavicle). The rotator cuff surrounds your shoulder joint.
The shoulder’s rotator cuff also consists of four muscles and tendons that allow the “ball” (humeral head) to rotate against the “socket” (glenoid). Rotator cuff tears most commonly involve the top rotator cuff tendon, called the supraspinatus, but any (or all) of the rotator cuff’s four tendons may be torn. In addition, there’s a small, fluid-filled sac that sits between the rotator cuff and a bone at the edge of your shoulder. This sac is called a bursa. The bursa can become inflamed (bursitis), and cause pain as well.
All these muscles and tendons work together to stabilize your shoulder and allow you to perform a wide range of movements, making it possible to lift or rotate your arm. When any part of the rotator cuff is injured or torn, it can cause pain and restrict your mobility.
What are the types of rotator cuff tears?
There are different types of rotator cuff injuries, including tears. The degree and severity of the injury will be dependent on several factors.
Most rotator cuff injuries may include:
- Shoulder tendonitis (rotator cuff tendonitis): This refers to inflammation of the shoulder joint tendons (this can also include the biceps tendon).
- Shoulder impingement (swimmer’s shoulder): This condition occurs when the rotator cuff rubs against the shoulder blade, resulting in pain, inflammation and limited mobility. This often occurs in swimmers and is sometimes referred to as “swimmer’s shoulder.”
- Partial tear (partial tendon rupture): In a partial rotator cuff tear, the tendon has torn but is still partially attached to the bone.
- Full thickness tear (rupture): This occurs when the tendon completely detaches from the bone.
Rotator cuff injuries can vary from simple inflammation to advanced tears. Shoulder experts at the Ohio State Wexner Medical Center can help make an accurate diagnosis.
Rotator cuff tear grading
Doctors use these grades to better understand the rotator cuff tear and to plan the right treatment to help the tendon heal.
Partial tear grading:
- Grade 1: The tear is small and affects only a tiny portion of the tendon. It may cause some pain and discomfort but doesn’t usually limit movement much.
- Grade 2: The tear is larger and affects a bigger portion of the tendon. It causes more pain and might limit some arm movements.
- Grade 3: The tear is significant and affects almost half of the tendon. It causes severe pain and makes it hard to move the arm.
Full thickness tear grading:
- Grade 1: The tear is small and affects only a tiny portion of the tendon but is completely detached from the bone. Pain is usually mild, but arm movement is limited.
- Grade 2: The tear is larger and affects a bigger portion of the tendon, still detached from the bone. Pain is more intense, and it is harder to move the arm.
- Grade 3: The tear is significant and affects most of the tendon, completely detached from the bone. Pain is severe, causing major difficulty in moving the arm.
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What causes rotator cuff tears?
Rotator cuff tears are caused by a variety of factors. There are some risk factors associated with the condition that may increase the likelihood of a rotator cuff injury or tear.
Some of the risk factors may include:
- Previous traumatic injury to the shoulder, including shoulder dislocation or a fall
- Chronic overuse and/or wear and tear on the tendon
- Frequent repeated movement of the shoulder, often associated with specific jobs or sports activities
- Age: the risk increases as you get older
- Poor posture
If you have any of these risk factors, it’s important to talk to your doctor about how you can prevent or reduce the risk of rotator cuff injuries and tears.
Rotator cuff tear symptoms
If you suspect you have a rotator cuff tear, you may experience symptoms that can affect your everyday life. These symptoms can make it difficult to use your shoulder normally. Some symptoms of rotator cuff injury or tears may include:
- Pain with daily activities, such as lifting the arm, carrying an object or lying on the shoulder
- Pain with job or recreational activities
- Loss of shoulder strength
- Loss of shoulder motion
Pain at night that makes it hard to sleep or causes you to wake up is common among people with a rotator cuff tear. In patients with large rotator cuff tears, the shoulder may become dramatically weaker, and/or you could be completely unable to lift your arm.
How is a rotator cuff tear diagnosed?
To find out if you have a rotator cuff tear, our sports medicine team will ask about your medical history and do a physical exam. This means checking where it hurts, how well you can move and how strong your shoulder is.
The doctor will usually order X-rays to evaluate your injury. They may also order an ultrasound. In some cases, you might also need a magnetic resonance imaging (MRI) scan to confirm any injuries, including tears, to see the extent of the injury and the best approach for treatment.
Treating rotator cuff tears
Rotator cuff tears are common and can cause pain or weakness. Gregory Cvetanovich, MD, an orthopedic surgeon, explains treatment options, both non-surgical and surgical.
Rotator cuff tear treatment
Most people who have rotator cuff tears don’t need surgery to relieve pain, improve motion, improve shoulder function and regain the functions of work, play and daily life.
Nonsurgical treatments
Nonsurgical treatments for injuries or minor tears include:
- Rest and activity modification
- Ice and heat
- Anti-inflammatory medication, including oral steroids or nonsteroidal anti-inflammatory drugs (NSAID)s
- Cortisone injections, when appropriate
- Physical therapy
It’s important to note that if your rotator cuff is torn, it will not heal on its own. However, these treatments can help reduce the pain and inflammation caused by a tear.
Rotator cuff surgery
If shoulder surgery is needed or if nonsurgical options fail, surgeons at the Ohio State Wexner Medical Center can perform rotator cuff surgery, which is typically a minimally invasive arthroscopic repair using a camera and small incisions in the shoulder. This procedure may result in less pain and a faster return to daily activities.
In many situations, other surgical repairs to the shoulder area may also need to be made. This can include other surgical procedures such as subacromial decompression, biceps tenodesis or distal clavicle resection.
In rare cases in which a tear is too advanced for a full repair to be performed, the Ohio State Wexner Medical Center can provide options for irreparable rotator cuff tear, including joint-preserving treatment, such as superior capsular reconstruction. Other times a reverse shoulder joint replacement (arthroplasty) is necessary to treat the injury.
How long does it take to recover from a torn rotator cuff?
The recovery process for rotator cuff repair surgery includes wearing a sling for about six weeks and beginning physical therapy shortly after surgery to keep the shoulder from becoming stiff.
Physical therapy involves implementing progressively more independent movements for about six months after surgery. Some people who have larger, more serious tears may take up to nine months or a year to regain full range of motion in their shoulder.