Anatomy
  • Your shoulder is a ball-and-socket joint made up of three bones: your upper arm bone (humerus), your shoulder blade (scapula), and your collarbone (clavicle).
  • Your arm is kept in your shoulder socket by your rotator cuff. The rotator cuff is a group of four muscles that come together as tendons to form a covering around the head of the humerus. The rotator cuff attaches the humerus to the shoulder blade and helps to lift and rotate your arm.
  • There is a lubricating sac called a bursa between the rotator cuff and the bone on top of your shoulder (acromion). The bursa allows the rotator cuff tendons to glide freely when you move your arm. When the rotator cuff tendons are injured or damaged, this bursa can also become inflamed and painful.
Description
  • When one or more of the rotator cuff tendons is torn, the tendon no longer fully attaches to the head of the humerus.
  • Most tears occur in the supraspinatus tendon, but other parts of the rotator cuff may also be involved.
  • In many cases, torn tendons begin by fraying. As the damage progresses, the tendon can completely tear, sometimes with lifting a heavy object.
  • There are different types of tears:
    • Partial tear: this type of tear is also called an incomplete tear. It damages the tendon, but does not completely sever it.
    • Full-thickness tear: this type of tear is also called a complete tear. It separates all of the tendon from the bone. With a full-thickness tear, these is basically a hole in the tendon which means it will not work properly.
  • Rotator cuff tears are very common. Over 20% of 30 year olds and 50% of 80 year olds will have asymptomatic (no pain) rotator cuff tears
Causes

There are 2 main causes of rotator cuff tears:

  • Acute tear
    • Fall down on an outstretched arm
    • Lift something too heavy with a jerking motion
    • Trauma
  • Degenerative tear
    • Most tears are the result of a wearing down of the tendon that occurs slowly over time. This degeneration naturally occurs as we age. Rotator cuff tears are more common in the dominant arm. If you have a degenerative tear in one shoulder, there is a greater likelihood of a rotator cuff tear in the opposite shoulder — even if you have no pain in that shoulder.
Symptoms
  • Pain at rest and at night
    • Worse if lying on the affected shoulder
  • Pain when lifting and lowering your arm or with specific movements
  • Weakness when lifting or rotating your arm
  • Crepitus or crackling sensation when moving your shoulder in certain positions.
  • Sudden acute tears cause intense pain and sometimes patients experience a snapping sensation
Treatment

Nonsurgical Treatment

  • Rest. Avoiding movements that exacerbate your pain.
  • Heat and Ice can be applied to reduce pain and swelling. Apply for 20 minutes at a time, several times a day, to keep swelling down. Do not apply directly to the skin.
  • Nonsteroidal anti-inflammatory medicines. Drugs like ibuprofen and naproxen reduce pain and swelling. Like any over the counter medication, please read and follow the label. If you have a history of stomach ulcers, bleeding ulcers or heart conditions, these medications might not be right for you. Consult your physician if you have any questions.
  • Physiotherapy. Under the direction of an experienced physiotherapists, many patients do well by:
    • Increasing Range of motion exercises and flexibility
    • Massage and TENS
  • Topical anti-inflammatories
    • Compound Topical Creams
    • Voltaren
  • Injections
    • Steroid (Depo-Medrol, Kenalog, Decadron)
    • Blood (PRP – Platelet Rich Plasma)

Surgical Treatment
In general, surgery is not an option for partial tears. These generally heal on their own with conservative (non-surgical) management. In full thickness tears, before surgery can be discussed, optimization of medication, physiotherapy and corticosteroid injections must be completed. If symptoms have lasted 6-12 months and you continue to have significant weakness and loss of function in your shoulder, surgery may be an option for you. Please speak to your surgeon to discuss if surgery is a good option for you.