Rotator cuff tears may be the most publicized of all shoulder problems. They are relatively common in those over the age of 40. There are many types and levels of tears from small partial thickness tears to full thickness tears involving one or more of the rotator cuff tendons. When caused traumatically, the pain, discomfort, and weakness is profound and leads to early evaluation and treatment. More insidious onset tears are often ‘dealt’ with for many weeks or months.
These tears can be from repetitive overuse or from a single traumatic event. The former is more common in older individuals and overhead athletes while the latter occurs with falls or in collision sport athletes. It is also very common to tear one or more of the rotator cuff tendons when a shoulder dislocation occurs.
- Pain with some or all motions
- Aching pain at night and after use
- Weakness with activities, especially overhead
- Trouble sleeping
- Limited motion secondary to pain or weakness
- Clicking or popping
The diagnosis of a rotator cuff tear can often be made through physical examination and X-rays. More advanced tears and questionable tears may require an MRI to determine the location and extent of the injury.
In most cases, once the diagnosis is made, therapy is begun to regain better motion and function of the shoulder. It is not uncommon that partial or small tears be treated conservatively depending on work and athletic interests. Exercises begin to reduce pain, then establish motion. Strengthening and a return to functional work or sport occurs only after the first two steps, pain reduction and improved motion, are achieved. Anti-inflammatories and Tylenol are often helpful during the early stages.
Alternative Treatment Options
When the tear is more serious, the individual desires to return to a high level of sporting activity, or conservative measures fail, surgery is recommended. Younger individuals, especially those with traumatically caused full thickness tears, can sometimes be treated most appropriately with early surgical intervention. Older individuals and those with overuse and/or degenerative tears can also be treated surgically but moving to surgery normally is delayed unless conservative measures fail (due to the relatively high success rate of conservative treatment in this group).
Surgical care involves the reattachment of the the torn tendons to the humeral head to their anatomic location. The repair can be performed often arthroscopically but may require skin incisions in more extensive injuries. Side-to-side tears can also occur and they are more easily fixed. Repairs are successful when both the tendon quality is good and the repair is done without significant tension. The reattachment is performed with the use of suture anchors or by placing sutures directly into the humeral head.
Rotator cuff tendon surgery is common and techniques are improving. However, any repair will fail if appropriate rehabilitation after the surgery is not performed. Most protocols begin very slowly with a period of no motion followed by a longer period of passive motion only. Only after the repair has healed should rehabilitation or normal daily activities begin.