What to Know About Rotator Cuff Tears

If your shoulder hurts and the pain won’t go away, it might be more than a shoulder strain. A rotator cuff injury is one of the most common causes of shoulder problems, especially in people over 40. It may start as a dull ache or mild discomfort when lifting your arm. Over time, the pain can become a constant problem. Rotator cuff injuries such as tears can interfere with sleep, work or exercise.

“A lot of people don’t realize how much they use the rotator cuff until it starts to hurt,” said Ryan Nixon, MD, an independent shoulder and knee orthopedic surgeon who chooses to practice at Franciscan Health. “It’s involved in almost every shoulder movement. When something’s wrong, your function takes a real hit.”

What Is The Rotator Cuff?

The rotator cuff is a group of four muscles and tendons. These keep the ball of your upper arm centered in the shoulder socket.

“It has two jobs: to move your arm and keep the shoulder stable,” Dr. Nixon said. “It helps lift the arm and rotate it, and it holds the ball of the shoulder in place. If you have a torn tendon, the ball starts to move up because the rotator cuff isn’t holding it down anymore.”

Rotator cuff injuries range from inflammation or irritation, also called shoulder tendonitis, to partial or complete tears.

“It’s a wide range,” Dr. Nixon said. “Some people have small frays that cause nagging pain. Others have a full tear and can’t lift their arm at all.”

What Causes A Torn Rotator Cuff?

A shoulder tendon tear, or torn rotator cuff, can cause lasting pain and weakness if left untreated. These injuries happen in several ways:

• Overuse or wear and tear: This is common in people over 40 who use their shoulders at work or in sports. “I see this a lot in people who do repetitive overhead work — painters, mechanics and athletes. Sometimes the tendon wears out over time,” Dr. Nixon explained. “We call this degenerative wear and tear.”
• Sudden injury: A fall, heavy lifting or a quick jerk can cause a tear, even in younger people. “You might feel a pop and lose strength right away.”
• Bone spurs: These are overgrowths on the shoulder bones that rub against the rotator cuff tendons. They cause pain and, over time, lead to tears.

Not everyone remembers a clear injury. Many people notice that the pain gets worse slowly over months or years.

What Are The Symptoms Of A Rotator Cuff Injury?

The signs of a rotator cuff injury like a tear include:

• Pain in the front or side of the shoulder
• Pain when you lift your arm or reach overhead
• Pain that wakes you up at night, especially when you lie on the sore side
• Weakness when you lift or rotate your arm
• Reduced range of motion
• Clicking or catching in the shoulder

“Some think it’s just shoulder arthritis or soreness, but if the pain doesn’t go away with rest, and you start to notice weakness, it’s worth getting checked,” Dr. Nixon said.

How Are Torn Rotator Cuff Tears Diagnosed?

A physical exam checks your strength and range of motion. An X-ray helps rule out arthritis or bone spurs.

“We usually need a magnetic resonance imaging (MRI) to see the soft tissue and get a clear picture of the rotator cuff,” Dr. Nixon said. “It shows us if there’s a tear, how big it is and if the tendon has pulled back.”

What Are The Treatment Options For Rotator Cuff Tears?

Not all rotator cuff injuries need surgery.

“Treatment depends on your age, activity level, how severe the tear is and how much it affects your life,” Dr. Nixon said. “If we scanned every 60-year-old, we’d find a rotator cuff tear in 28 percent of shoulders. Not all tears cause pain.”

Nonsurgical treatments for rotator cuff injuries include:

• Rest and avoid painful movements
• Anti-inflammatory drugs
• Physical therapy to build strength
• Steroid injections for pain relief

“Many people feel better with therapy and injections, especially for partial tears or inflammation,” he said.

Rotator cuff surgery becomes an option if:

• The tear is large or complete
• Pain continues despite conservative treatment
• There is serious weakness or loss of function
• The tendon has retracted and could get harder to repair over time

“We try nonsurgical options first,” Dr. Nixon said. “But if things don’t improve, arthroscopic shoulder surgery can restore function and reduce pain.” In severe cases, you may need shoulder replacement or reverse shoulder replacement.

While treatment is important, prevention can make a big difference, especially as we age. You can also learn how to help prevent rotator cuff injuries  through exercise, posture and shoulder care.

How Long Does Recovery Take?

Recovery from rotator cuff surgery takes time. You’ll likely wear a sling for several weeks and then start physical therapy.

“It’s a longer recovery than some expect,” Dr. Nixon said. “But for the right patient, it’s worth the effort.”

Don’t Ignore Ongoing Shoulder Pain

Rotator cuff injuries don’t always heal on their own. If shoulder pain limits your movement or keeps you up at night, talk to an orthopedic specialist.

“The sooner we catch it, the more options we have,” Dr. Nixon said.

If shoulder pain interferes with your life, Franciscan Health and our orthopedic partners offer expert orthopedic shoulder treatment to help you recover strength and mobility.