Rotator Cuff Tear

A rotator cuff tear is a tear in one of the four tendons that lift and rotate the shoulder. The tear can be partial or go all the way through the tendon. Some tears follow a single injury, such as a fall onto the arm or a heavy lift. Many others develop gradually as the tendon wears with age and overhead use, often with no clear injury. A torn tendon does not heal back together on its own, but the shoulder can still be managed well, and most people improve without surgery.

Common symptoms include:

• Pain over the outer shoulder and upper arm, often worse at night and when lying on that side
• Weakness lifting or rotating the arm, especially reaching overhead
• Trouble with everyday reaching, such as a seatbelt or fastening clothing behind the back
• A grinding or catching feeling with movement

Diagnosis starts with your history and a hands-on exam of the shoulder's motion and strength, with an in-office X-ray and a check of the neck to rule out a pinched nerve. The X-ray shows bone rather than tendon, so a shoulder with a cuff tear often looks normal on the film, and it mainly rules out arthritis and other causes. To see the tendon itself, an MRI is ordered, though not in every case: it is used when the tear follows a recent injury, when a full-thickness tear is likely in a younger, active patient, or when surgery is being planned, since the MRI shows the tear's size and the condition of the muscle. Many tears are diagnosed and managed without one.

Most tears are treated without surgery first:

• Activity changes to ease overhead reaching and lifting
• Physical therapy to strengthen the surrounding muscles, the core of treatment
• Anti-inflammatory medication for pain and swelling
• A corticosteroid injection in some cases to calm pain

Surgery is considered when a tear keeps limiting daily life despite a real effort at nonsurgical care, for larger full-thickness tears, or for higher physical demands. Repair reattaches the tendon to the bone.

• Rotator cuff repairShoulder
• Reverse shoulder replacementShoulder

For a fuller explanation, including anatomy, diagnosis, and the full range of treatment:

• Rotator cuff tears — AAOS OrthoInfo