The rotator cuff is a group of muscles that forms a common tendon that helps to stabilize the shoulder. The rotator cuff can tear either by tissue degeneration over time or from an acute traumatic episode. Sometimes the rotator cuff tear will be due to both of these factors. Rotator cuff tears can lead to pain and/or weakness in the shoulder.
How it happens
Over time, the rotator cuff tissue degenerates. This is in large part due to the blood supply of this tendon, which is somewhat limited. The rotator cuff tendon may also tear due to chronic repetitive trauma, or a single traumatic episode.
How it feels
Rotator cuff tears can cause pain in the shoulder. This pain may be felt deep in the shoulder, or along the lateral arm. Rotator cuff pain may also be referred down the arm and patients may feel the pain along the upper arm, or even into the forearm or hand. When the rotator cuff tendons are torn, the shoulder may be weak. This weakness may also be accompanied by pain, when trying to lift objects or trying to use the arm overhead or in a forceful manner. The rotator cuff tear can often be diagnosed by physical examination; however, magnetic resonance imaging (MRI) of the shoulder can be helpful to determine if the rotator cuff is torn.
How it is fixed
Symptomatic rotator cuff tears may be treated non-operatively or with surgery. If the symptoms have been going on a short time and there is no acute trauma, non-operative management may be appropriate. Non-operative management includes physical therapy, anti-inflammatory medication and/or cortisone injection. Rotator cuff repair surgery is appropriate for patients who have longstanding symptoms that do not respond to non-operative management. Surgery is also appropriate for rotator cuff tears that occur following trauma leading to severe weakness in a patient who had a previously normal shoulder. The rotator cuff is repaired to the bone using sutures to stitch the tendon back into its normal position. Rotator cuff surgery, when done technically well for the appropriate patient, has a high rate of success with the vast majority of patients experiencing a significant improvement.
After rotator cuff repair surgery, patients generally wear a sling for their arm for a total of six weeks. They have several months of physical therapy to recover their range of motion and strength. The vast majority of patients experience a significant improvement in their symptoms, when rotator cuff repair surgery is done appropriately for correctly selected patients.