What is a Rotator Cuff Tear?

A rotator cuff tear is a common cause of pain and disability among adults.

A torn rotator cuff will weaken your shoulder. This means that many daily activities, like combing your hair or getting dressed, may become painful and difficult to do.

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Rotator Cuff Tears of the Shoulder

A rotator cuff tear is a tear to the tendons of the shoulder joint that attach to the outer part of the ball. They function to allow you to elevate your shoulder over your head or abduct your shoulder with your elbow away from your side and do things away from your body, reaching, lifting, that sort of thing.

It’s made up of a large tendon on the front called the subscapularis, and the main tendons on the top part of the shoulder are the supraspinatus, the infraspinatus, and the teres minor. They all form one large tendon that covers the ball.

When they tear, it usually tears through the supraspinatus first and then works its way posteriorly into the infraspinatus and other tendons as it gets larger.

The main cause of rotator cuff tears is, unfortunately, just getting older. It’s usually degeneration of the tendon. You may have silent tearing going on and not realize it and not have any symptoms until it reaches a size of tear that becomes symptomatic.

Then you’ll have pain and weakness, difficulty lying on that side. You may also have a smaller tear and suffer an injurious event that causes the tear to get bigger or causes the tear to become symptomatic.

That’s the majority of patients that we see with rotator cuff tears. They’re the older population with degenerative tendons. You do get a small percentage of the population that get full thickness tears from a large trauma, but it’s usually a significant event that occurs to cause it.

Those patients will present with inability to elevate the arm actively. They’ll have quite acute pain right over where the rotator cuff attaches and it’s quite specific in nature. Those are the main causes of rotator cuff tears.

Making the diagnosis of a rotator cuff tear usually comes from a thorough history and physical exam of the patient. There are hallmark signs from the history and the examination that can often tell you that somebody has a torn rotator cuff.

If there’s any uncertainty, then the next line of information to obtain would be imaging, which would start with radiographs of the shoulder joint. Then to assess the rotator cuff itself, one could get an ultrasound or an MRI of the shoulder, which will tell you the status of the rotator cuff tendons. Local Physiotherapist 

Treatment for rotator cuff tears really depends on the patient’s presentation. If symptoms are low grade, one would generally start with physiotherapy to help decrease their symptoms, improve their strength, get them functioning a little better.

If that fails, then one could consider a cortisone injection into the subacromial space, which is the area where the rotator cuff tendons sit about the shoulder. And if you’re planning on that, then either your family doctor or a referral to an orthopedic surgeon to do that would be indicated.

Failing any non-surgical treatment for a rotator cuff tear brings you into the realm of considering a surgical repair or re-attachment of the torn tendon back onto the bone where it was previously attached. Those are the three main treatment options for rotator cuff tears. Local Orthopedic Surgeon

If you’re a patient who is suffering with shoulder pain that’s located around this area of the shoulder or pain with actively moving the shoulder or lifting or finding a weakness with that, then you should seek the advice of a physiotherapist, your family doctor, and consider getting a referral to an orthopedic surgeon as you may have a rotator cuff tear that needs formal treatment.

Presenter: Dr. Jordan Leith, Orthopaedic Surgeon, Burnaby, BC

Local Practitioners: Orthopaedic Surgeon

Quiz: Do You Understand Shoulder Surgery?

Test your knowledge by answering the following questions:

Questions
True
False
1

The usual treatment for shoulder injuries is surgical options.

Explanation:
The usual treatment for shoulder injuries is non-surgical options such as medications, bracing and physiotherapy. Shoulder surgery is generally only explored if the non-operative options fail.
2

Arthroscopic shoulder surgery is often performed to repair soft tissue injuries.

Explanation:
Arthroscopic shoulder surgery (otherwise known as keyhole surgery) can be a good option for some patients. It is often performed to repair soft tissue injuries, and enables surgeons to introduce a fiber optic camera through a two- to three- millimeter incision.
3

For more severe shoulder injuries, surgeons may recommend a reverse shoulder replacement surgery.

Explanation:
For more severe shoulder injuries, surgeons may recommend a reverse shoulder replacement surgery. It is often done to repair rotator cuff tendons that have been damaged, often by arthritis.
4

Patients with recurrent shoulder dislocations may won't benefit from surgical reconstruction, only from non-surgical options.

Explanation:
Patients with recurrent shoulder dislocations may benefit from surgical reconstruction of the damaged tissues in the shoulder joint. This usually involves an arthroscopic day procedure, where the surgeon identifies the torn labrum or ligaments that have occurred with each shoulder dislocation.
5

Following shoulder surgery, most patients will benefit from physiotherapy.

Explanation:
Following shoulder surgery, most patients will benefit from physiotherapy to get their range of motion back, decrease pain and increase strength.
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