Anatomy

Rotator cuff muscles diagram

Your shoulder is a large ball-and-socket joint. The rotator cuff is a collection of muscles and soft tissues (tendons) responsible for keeping your arm bone firmly attached to the socket.

About

When your shoulders are injured, it may be a rotator cuff tear. Tears are divided into categories based on their severity:

  • Partial or incomplete tears – When the tendon in question is damaged but not entirely torn
  • Complete tears – (Known as full-thickness tears) happen when the injured tendons are torn completely away from the bone

Causes

Rotator cuff tears result from either acute events or chronic deterioration.

Acute injuries are from immediate tendon damage. Common examples include falling on an outstretched arm, forceful physical contact, or lifting an especially large or heavy object.

The natural aging process often causes chronic deterioration. For example, you put extended wear on your arms as you get older, placing regular but significant strain on muscles and soft tissues.

As you age, you often experience a decreased blood supply to your rotator cuff. Such events leave the surrounding tissues unable to repair minor damages, resulting in partial or complete tears.

Additionally, age increases your risk of bone overgrowth, known as bone spur development, in the bones surrounding your rotator cuff. Overextended bones bring forth a condition called shoulder impingement. Shoulder impingement places pressure on nearby tendons which leaves you prone to tears.

Get tips for protecting yourself from rotator cuff tears and other causes of shoulder pain from playing pickleball.

Risk factors

Specific actions, events, or circumstances can increase your risk of rotator cuff tears, including:

  • Age – If you are age 40 and older, your chances rise significantly
  • Professional or recreational activities – Professional or recreational athletes who engage in repeated, sometimes violent throwing motions like baseball pitchers and tennis players carry an increased risk
  • Profession – If you are employed in a job where continual overhead shoulder motions are used, such as painting and carpentry, your probability of encountering a rotator cuff tear increases

Symptoms

The most obvious symptom of a possible rotator cuff tear is pain. In acute injuries, this pain often appears immediately following the incident in question, can be intense, and might spread down your arm.

Gradual deterioration might produce symptoms like:

  • Pain that worsens when engaging in activities like lifting or sports competitions
  • Progressive weakness
  • Difficulty moving your arm up or down
  • Inability to perform basic actions such as dressing or combing your hair

In a small number of instances, you might not experience any pain. Most rotator cuff tears will produce a certain degree of shoulder or arm weakness.

Complications

If left untreated, partial tears can gradually worsen and possibly progress to full tears needing quicker, aggressive, and more intense treatment. This could heighten your risk of injuring other important physical components found in your arm or shoulder.

Man with shoulder pain from lifting arm when weightlifting

Diagnosis

Your doctor typically begins the diagnostic process by performing a close examination of your shoulder by:

  • Looking out for any visual abnormalities
  • Testing the shoulder’s motion range
  • Measuring the affected arm’s strength levels
  • Asking you to move your arm and shoulder in several different directions

Your doctor might also touch your shoulder to gauge your pain threshold and identify any tender locations.

Your physician may request that you undergo internal imaging tests. Devices such as X-rays or magnetic resonance imaging (MRIs) capture pictures of your arm and shoulder’s inner workings.

Treatment

The specific therapy your doctor prescribes will depend on factors like your:

  • Age
  • Fitness level
  • General health
  • Injury’s severity

As many as 80 percent of all rotator cuff tears respond to non-surgical treatments, resulting in less pain and increased shoulder mobility.

Nonsurgical treatments

Commonly employed nonsurgical treatments include resting the affected shoulder, refraining from pain-causing activities, ingesting over-the-counter or prescription pain medications, completing a physical therapy program, or receiving steroid injections.

Surgical treatments

If you do not see improvement with nonsurgical treatments or if you have severe or complete tears, surgery might be needed. Usually, your doctor will recommend surgery to reattach the torn tendon and repair neighboring injured structures if:

  • Your symptoms have lasted from six months to a year or longer
  • A large tear has been diagnosed, and the surrounding tissues are in good condition
  • The injury resulted from an acute accident or fall
  • You have noticeable weakness or pain, limiting your ability to perform routine activities

There are several types of surgeries undertaken. Certain procedures are more invasive than others. You and your doctor will determine which is most suitable for you based on the factors above. Any surgical procedure will likely need a recovery period of shoulder immobility, required rest, and physical therapy.

Prevention

It is impossible to prevent rotator cuff tears from acute incidents. You may be able to delay the onset of chronic events by keeping the muscles, bones, and soft tissues of your shoulder firm and flexible by routinely performing various stretching exercises.

Prognosis

Treatment is successful in a significant percentage of cases. If you undergo corrective surgery, the recovery process will be longer. It is important to remember that everyone heals at their own pace and is often contingent on many underlying issues.

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