Rotator Cuff Tears

The shoulder is a complex joint that contains multiple bones, ligaments, tendons and muscles all working together to facilitate normal function and movement.

What is a rotator cuff tear?

A rotator cuff tear occurs when one or more of the tendons attaching the muscles to the bone is torn. A rotator cuff tear may be partial- (incomplete tear) or full-thickness tear (complete tear). A partial tear is when one of the tendons of the rotator cuff is frayed or damaged. A complete tear is when a tear completely detaches the tendon in half or pulls the tendon off the bone.

Rotator cuff tears are the primary cause of shoulder pain and dysfunction. Every year, as many as 2 million Americans suffer from a rotator cuff tear. Rotator cuff tears make it difficult to perform even the simplest of everyday activities like dressing, combing your hair and brushing your teeth.

Anatomy of the rotator cuff

The shoulder is made up of three bones: upper arm bone (humerus), shoulder blade (scapula), and the collarbone (clavicle). The shoulder is a ball-and-socket joint: the ball, or head, of your upper arm bone fits into a shallow socket in your shoulder blade.

The rotator cuff is a group of four muscles and their tendons that form a cuff around the shoulder joint, secure the upper arm bone (humerus) in the joint and provide strength and stability for all shoulder. The rotator cuff helps to raise and rotate your arm.

The four rotator cuff muscles and tendons are as follows:

1. Supraspinatus
2. Infraspinatus
3. Teres Minor
4. Subscapularis

The supraspinatus sits on top of the shoulder and helps raise the arm. It is the most commonly torn rotator cuff tendon. The infraspinatus runs behind the supraspinatus and helps externally rotate the shoulder. The teres minor lies behind the infraspinatus and externally rotates the shoulder when the arm is raised. Last, the subscapularis runs in the front of the shoulder and assists with internally rotating the shoulder.

What causes a rotator cuff tear?

Acute Rotator Cuff Tear – an acute rotator cuff tear is the result of a sudden injury such as a slip-and-fall accident, sports injury or other traumatic injury. Acute rotator cuff tears can occur with other shoulder injuries, such as a broken collarbone or dislocated shoulder.

Degenerative Rotator Cuff Tear – are more common than acute rotator cuff tears. Degenerative rotator cuff tears are the result of a wearing down of the tendon, which occurs slowly over time. This degeneration naturally occurs as we age. Degeneration can occur more rapidly as a result of repetitive stresses, lack of blood supply and bone spurs. Rotator cuff tears are more common in the dominant arm.

What are the symptoms of a rotator cuff tear?

Symptoms of a rotator cuff tear include:

• severe pain after injury
• pain at night
• pain that radiates down the arm
• pain with overhead activities
• shoulder stiffness
• decreased range of motion
• weakness

Be aware, however, that some rotator cuff tears are not painful. These tears may still result in arm weakness and other symptoms.

How is a rotator cuff tear diagnosed?

The diagnosis of rotator cuff injury is based off of a thorough history, physical examination and various imaging techniques. Dr. Godin will first conduct a thorough examination of the affected shoulder, specifically to identify any physical deformities, abnormal weakness, or muscle wasting. He also will assess passive and active range of motion as well as strength of the affected shoulder. Special physical examination tests can help determine which parts of the rotator cuff are affected as well as the severity of the injury.

If necessary, muscle and tendon damage can be further examined through multiple imaging techniques, including X-rays and magnetic resonance imaging (MRI) of the affected shoulder. 

How is a rotator cuff tear treated?

First, it should be noted, that if a rotator cuff tear is left untreated, a tear can enlarge, and cause more damage. The goal of rotator cuff treatment is to relieve pain and improve function. As with most orthopedic injuries, treatment is determined by the severity of your rotator cuff tear, your needs and goals.

Non-surgical treatment

Non-operative treatment is almost always the first-line therapy for rotator cuff treatment of partial tears. Rest, activity modification, anti-inflammatory medications, strengthening exercises and physical therapy can be very effective in restoring normal function and reducing pain. Steroid injections may help to reduce inflammation.

When symptoms persist after a trial of physical therapy, and pain interferes with sleep and daily activities or when there is a severe tear and significant loss of function, board-certified orthopedic surgeon Dr. Jonathan Godin may recommend surgery.

Rotator cuff repair surgery

The goal of surgery is to heal the torn tendon, restore function and prevent added damage to the joint. Many surgical repairs can be performed on an outpatient basis using a minimally invasive procedure called arthroscopy.

Arthroscopic Repair

Under anesthesia, a tiny camera (arthroscope) is inserted through small incisions into the shoulder allowing Dr. Godin to see inside the joint and perform the repairs, as well as addressing other problems like bone spurs, biceps tendon tears, and other damage. Arthroscopic surgery is associated with reduced tissue damage, faster recovery, and less post-op discomfort when compared to open surgical techniques.

Mini-Open Repair

Advances in shoulder arthroscopy and repair techniques have made mini- open repair less popular. This technique may be appropriate for certain patients who require a donor tissue patch augmentation to the rotator cuff repair. It provides for an arthroscopic assisted mini-open repair. During this procedure all damaged tissue is repaired, and bone spurs are removed. Then a 2-3-inch incision is made to repair the cuff, tendons are reattached the tendons.  This technique has been replaced by the All-Arthroscopic repair in many cases.

Superior capsule reconstruction

Dr. Godin also performs a new procedure called superior capsule reconstruction (SCR) for select patients who have a rotator cuff tear that is so large and retracted that it cannot be repaired. This surgery is indicated in patients who have minimal to no shoulder arthritis in the setting of a massive irreparable rotator cuff tear.

Following surgery, physical therapy is essential to restore strength and function to the joint. You will wear a sling for the first few weeks to stabilize and support the joint as it heals. Complete recovery can take from four to six months or longer for large or complex tears.

Dr. Jonathan Godin is a renowned orthopedic surgeon with superior training, expertise and experience, at the world-class Steadman Clinic in Vail, Colorado. He is devoted to his patients and committed to delivering the best possible outcomes for them. When you or a loved one has a shoulder, hip or knee problem, contact Dr. Godin to schedule a consultation. He welcomes national and international patients who seek premium care.