What is the Rotator Cuff?
The rotator cuff is a structure located in the shoulder. It consists of a group of muscles and tendons connecting the joint to the arm, allowing free movement.
These muscles helps the arm lift and rotate as well as keeping it attached to the shoulder socket. If these suffer any injury, it can restrict movement and cause discomforts to the affected.
A rotator cuff tear is a widespread condition. It can be caused by injuries or repetitive movements. It can also occur as the result of natural wear and tear that comes with aging. (1)
Four muscles are included in the rotator cuff: supraspinatus, infraspinatus, teres minor and subscapularis. These are fundamental parts of the shoulder as they provide support to different joints and allow them to move freely.
In some cases, the functions of the rotator cuff can be compromised by a condition called tendinitis. This ailment will irritate the tendons and cause inflammation in a small cushion (bursa) located between a bone and joint. (2)
However, a tear in the rotator cuff is one of the most common causes of pain and disability of the shoulder. In the U.S., it accounts for 4.5 million doctor visits each year. (3)
When the area suffers damage it becomes very vulnerable, and each movement may cause more profound injury.
A rotator cuff tear will affect people in different ways. Some have certain symptoms while others can have a completely different set.
Below are some common ways a rotator cuff tear may affect daily life:
When the rotator cuff is injured or worn down, it can make everyday tasks nearly impossible.
Those affected often experience restricted or limited range of motion in the shoulder. This is usually a result of a tear or injury to the supraspinatus muscle. (4)
This muscle helps with the elevation of the shoulder, which is required for a full range of motion.
Upper body range is essential for daily activities such as combing hair or reaching a shelf. Those affected might perceive the arm to be heavy, and just elevating the hand can seem like a strenuous task. It is not necessarily painful, but it’s nonetheless a debilitating symptom. (5)
A tear in the rotator cuff is very likely to cause pain. Depending on the person and how deep the injury is, it may range from mild discomfort to a sharp stinging pain. It may be more apparent during the night where it might become so severe it will wake the affected. (6)
People with a rotator cuff injury might exhibit mild joint pain at first which may be a minor annoyance. However, over time, the pain may worsen, and it might be felt even while the person is at rest. The affected might feel as though it is spreading down the arm.
When the body suffers an illness or injury, it will launch an inflammatory response which triggers swelling. This might be either internal or external. (7)
The swelling is likely to cause pain, even though it might not always be visible from outside. (8)
Stiffness and Cracking
A rotator cuff tear or injury can cause the shoulder to make a clicking sound when it moves. These sounds may be associated with stiffness where some may hear popping or even cracking. People often exhibit this symptom when they suffer from a chronic tear. (9)
This symptom will generally appear when lifting heavy objects or straining the shoulder. (10)
The rotator cuff is prone to natural wear and tear that comes with aging. However, disease or injury to the shoulder may speed up this process. An ailment to the area occurring during younger years is likely to lead to a tear in the area earlier than expected.
Rotator cuff damage has been laid out over three stages to explain the progress from an early untreated injury to a partial or full-thickness tear of the muscles. (11)
Damage to the rotator cuff can often remain unnoticed if the symptoms are mild. Doctors may even find it difficult to diagnose based on complaints of the patient, as these may also be indicators of other issues. (12)
Early age onset is characteristic of the first stage. It is generally classified in patients younger than 25 years of age. These could have suffered an injury which has caused swelling or perhaps a tear in a blood vessel causing bleeding near the bursa or tendon.
The patient may exhibit pain or discomfort while performing specific movements with the arm or shoulder, as well as a reduced range of motion.
At this stage, the patient is likely to suffer from tendinitis and fibrosis as a natural response from the body.
The occurrences of the previous stage have led to inflammation and irritation of the rotator cuff as it is trying to repair itself. It may be characterized by restricted movement followed by weakness and pain. This phase usually manifests between the ages of 25 to 40.
The last stage presents with either a partial or full-thickness tear of the rotator cuff. Injuries afflicted have led to ruptures and bony spurs which are very likely to cause significant pain and limited range of motion.
Partial-thickness tears usually heal or become profoundly smaller over time. Damage which is full-thickness will usually not heal on its own and may need surgery to repair.
To diagnose a rotator cuff tear doctors rely upon detailed medical history, a physical examination and imaging technology such as x-rays and MRI’s. (13)
As we established earlier, doctors must be careful in their investigation as symptoms can be misleading. Various shoulder maneuvers performed during a physical examination can indicate damage to the rotator cuff.
There are two main approaches to treatment:
Non-surgical treatments depend on the severity of the tear. They will often work to improve pain and weakness as well as enhancing the range of motion. (14)
Options can include occupational therapy which involves different exercises and stretches; this is conducted with a physical therapist.
Other times the doctor might prescribe oral medication that will help improve inflammation and reduce symptoms. These may include ibuprofen or acetaminophen. (15, 16)
In some cases, the doctor might prefer to prescribe steroids either in pill form or by injection.
Surgery is generally considered if other options fail to work, or in cases where too much movement could worsen the tear. (17)
There are different surgical options available, but like any procedure, they do come with possible complications. (18)
Following surgery, doctors are likely to recommend rehabilitation therapy to restore strength and range of motion.
During this procedure, the surgeon will arrange small cuts along the shoulder where a tube attached to a camera and tiny instruments will be inserted. By looking at a screen, the specialist can perform a repair which usually involves stitching the tear back together. (19)
Open surgery requires a more extended incision in the shoulder to expose the rotator cuff so the surgeon can readily repair the tear. It is usually considered an option when the tear is more significant. (20)
This surgery is a mix of those mentioned above. A surgeon will make a small cut into the shoulder using an arthroscope. Once through to the muscle, conventional surgical instruments will be used to repair the damage. (21)
This procedure won’t necessarily affect the muscle as much as full open surgery, so recovery time may be quicker.
What is the rotator cuff? The rotator cuff is a collection of muscles inside the shoulder which provide support during movement.
What are the signs of rotator cuff damage? Indicators that the rotator cuff is damaged can include weakness and mild to severe pain, restricted movement and swelling.
How do you acquire damage to the rotator cuff? Damage can occur due to direct trauma or overuse of the shoulder. Sometimes an infection in the surrounding tissues and tendons may also compromise its functions.
How are you diagnosed for a rotator cuff tear? Doctors generally utilize a three-way approach: medical history, a physical examination, and imaging tests. X-rays and MRI’s can show the extent of the tear. (22)
What is the best treatment for a rotator cuff tear? Doctors usually refrain from pinpointing a specific treatment as the best option, since every case is different. Non-surgical options are usually considered first, however surgery is sometimes needed to repair the tear. (23)
What are the long term complications of a damaged rotator cuff? A tear in the rotator cuff can become chronic, where the sufferer may experience joint pain and restricted movement on a daily basis. (24)
Is a rotator cuff tear considered a disability? This is generally not regarded as a disability. However, it can be physically disabling for the affected.
Is there any cure for a rotator cuff tear? Yes, it can be healed with treatment, either surgical or therapeutic. In some cases, it will heal on its own.
Is a rotator cuff tear life threatening? No, but it can cause debilitating pain.
The rotator cuff is a support system located in the shoulder, consisting of a group of muscles.
These muscles are likely to suffer from natural wear and tear occurring over time. However, sometimes damage to the area can injure the already vulnerable group.
This can trigger debilitating symptoms such as pain and weakness, loss of strength and range of motion. This may sometimes require surgery to repair. Fortunately, many times the tear is likely to recover on its own over time.