What is the rotator cuff and what does it do?

The rotator cuff is a group of four muscles that surround the shoulder joint, keeping the head of your upper arm bone firmly within the shallow socket of the shoulder. Thus, the rotator cuff stabilize the ball of the shoulder within the joint and there by helps to lift and rotate the arm.

What Is a Rotator Cuff Tear?

A rotator cuff tear is a rip in the Rotator Cuff muscle tendon complex.

There are two kinds of rotator cuff tears.

A partial tear is when one of the muscles that form the rotator cuff is frayed or damaged.

The other is a complete tear. That one that goes all the way through the tendon or pulls the tendon off the bone.

What are the Causes and Risk Factors?

A rotator cuff tear :-

1)   May result from an acute injury, such as a fall

2)   May be caused by wear and tear with degeneration of the tendon.

A rotator cuff tear resulting from injury can happen to anyone but the risk of a degenerative tear goes up with:

  • Occupation. Jobs like house painters and construction workers put you at a higher chance of rotator cuff tears.
  • Lack of blood supply. As you get older, you get less blood to your rotator cuff area, which makes small tears hard to repair, leading to larger tears.
  • Bone spurs. Bone overgrowth in the shoulder, which happens more often as you get older, can wear away the rotator cuff tissues and cause tears. 
  • Age. Rotator cuff tears are most common in people over 60.
  • Athletics. Baseball, tennis, rowing, and weightlifting are sports that stress your rotator cuff and put you at risk of tears.

how would I know if I have a rotator cuff tear?

If the tear occurs with injury, you may experience acute pain, a snapping sensation, and immediate weakness of the arm.

With degenerative tears, typically, you will feel pain in the front of your shoulder that radiates down the side of your arm. It may be present with overhead activities such as lifting or reaching. You may feel pain when you try to sleep on the affected side. You may note weakness of your arm and difficulty with routine activities such as combing your hair or reaching behind your back.

The pain associated with a rotator cuff injury may:

·       Be described as a dull ache deep in the shoulder

·       Disturb sleep

·       Make it difficult to comb your hair or reach behind your back

·       Be accompanied by arm weakness

Pain may-not be there in some cases of rotator cuff tears. But in some cases, you might:

  • Have trouble raising your arm
  • Feel pain when you move your arm in certain ways or lie on it
  • Have weakness in your shoulder
  • Be unable to lift things like you normally do
  • Hear clicking or popping when you move your arm


If I have a painful rotator cuff and keep using it, what will happen?

If you don’t do anything about a torn rotator cuff, you can have more serious problems over time.

A rotator cuff tear can extend or get larger over time. This can occur with repetitive use or a re-injury. It is common for patients with known rotator cuff disease to have acute pain and weakness following a minor injury. This likely represents extension of an existing tear.

Without treatment, rotator cuff problems may lead to permanent loss of motion or weakness, and may result in progressive degeneration of the shoulder joint called arthritis. Although resting your shoulder is necessary for your recovery, keeping your shoulder immobilized for a prolonged time can cause the connective tissue enclosing the joint to become thickened and tight (frozen shoulder).

both frozen shoulder and arthritis are harder to treat and the treatment results may not be very good.

How is rotator cuff tear diagnosed?

To find out if you have a torn rotator cuff, your doctor will start with a history of the injury and a physical examination of the shoulder. During the physical exam, your doctor will press on different parts of your shoulder and move your arm into different positions. He or she will also test the strength of the muscles around your shoulder and in your arms.

In addition, your doctor may use one of the following:

         X-rays to see if the top of your arm bone (humeral head) is pushing into your rotator cuff space.

         MRI, which uses radio waves and a powerful magnet to make detailed pictures of your shoulder.

         Ultrasound to see the soft tissues (tendons, muscles, and the bursas) in your shoulder.

Can a rotator cuff tear be healed without surgery?

Many rotator cuff tears can be treated without surgery. Anti-inflammatory medication, shoulder joint injections, physical therapy and exercises may all be of benefit in treating symptoms of a cuff tear. The goals of treatment are to relieve pain and restore strength to the involved shoulder. Even though most tears cannot heal on their own, good function and pain relief can often be achieved without surgery.

If, however, you are active and use your arm for overhead work or sports, then surgery is most often recommended because many tears will not heal without surgery.

At what point does a rotator cuff tear require surgery to fix it?

Surgery is recommended if you have persistent pain or weakness in your shoulder that does not improve with nonsurgical treatment. Frequently, patients who require surgery will report pain at night and difficulty using the arm for lifting and reaching. Many will report ongoing symptoms despite several months of medication and limited use of the arm.

Surgery is also indicated in active individuals who use the arm for overhead work or sports. Pitchers, swimmers, and tennis players are common examples.

What options are available for surgical repair?

It’s likely your doctor will reattach the tendon to the bone. In some cases, they might need to take out small pieces bone that are stuck in your shoulder joint, or remove small areas of bone or tissue to give your tendon more room to move.

Types of rotator cuff surgery:

1) Arthroscopic: Your doctor will make a small cut in your shoulder then use an arthroscope (a tube with a small camera and tiny instruments) to fix the tear. This means your wound will be smaller than it would with another type of surgery.

2) Open: Your doctor uses a larger skin cut to go into the muscles of your shoulder and fix the tear.

3) Mini-Open: This uses a skin cut smaller than open procedure and larger than that would be with arthroscopic surgery. This combines the principles of both arthroscopic and open surgery. In fact, your doctor may start with the arthroscope for the initial steps and finishes with larger instruments.

Sometimes it may not be possible to reattach your torn tendon. In such situations other surgeries are to be done to regain the function of your shoulder and for relief of symptoms. These can be: -

1) Tendon transfer: If your rotator cuff tendon is too torn to reattach, the doctors can use another nearby muscle tendon.

2) Shoulder replacement: If the rotator cuff tear is large enough, you may need to have your shoulder joint replaced.

Your orthopedic surgeon can recommend which technique is best for you.

How important is rehabilitation in the treatment of a rotator cuff tear?

Both in the nonsurgical and surgical treatment of a rotator cuff tear rehabilitation plays a critical role.

Even though surgery repairs the defect in the tendon, the muscles around the arm remain weak, and a strong effort at rehabilitation is necessary for the procedure to succeed.

Also not moving your shoulder (with or without surgery) can lead to stiffness of shoulder called frozen shoulder mentioned above. Not doing rehabilitation properly can take away all the benefits of doing surgery and the end result can be even worse.

Complete rehabilitation after surgery may take several months.

Your orthopedic surgeon can prescribe an appropriate program based on your needs and the findings at surgery.

When will you be able to use your hand normally after surgery?

It varies from patient to patient, and also depends on the findings during surgery. In most cases it can take few months before you can use your hand normally.