What is a rotator cuff tear?

Many people know all too well the pain of a rotator cuff tear. It is a common cause of pain and disability among adults. In fact, nearly 3 million people in the United States each year see their doctors because of a rotator cuff problem. Dr. Jonathan Myer, an orthopedic surgeon affiliated with Sharp Grossmont Hospital, shares what patients need to know about this common condition.

What is the rotator cuff?
The rotator cuff is a group of tendons and muscles that surround the shoulder joint, connecting the upper arm to the shoulder blade. The rotator cuff tendons provide stability to the shoulder; the muscles allow us to lift the arm and rotate it. Too much stress can cause partial tears, fraying or swelling in the tendons. Abrupt stress may even cause one of the tendons to pull away from the bone or tear in the middle. Most tears are the result of a wearing down (degeneration) of the tendon that occurs slowly over time.

What are the symptoms?
A rotator cuff tear often occurs in people who repeatedly perform the same shoulder motions. They tend to develop gradually, but can also happen suddenly.

Symptoms of rotator cuff tear may include:

• Pain — that varies — in the shoulder and arm

• Weakness and tenderness in the shoulder

• Difficulty moving the shoulder, especially when trying to lift the arm above the head

• Snapping or crackling sounds when moving the shoulder

• Inability to sleep on the shoulder

How do you diagnose a torn rotator cuff?
It starts with an office visit and examination. To measure the range of motion of the shoulder, I have the patient move his or her arm in several different directions and test for arm strength. I also rule out other conditions, such as arthritis. Other tests that may help us confirm a diagnosis include X-rays, magnetic resonance imaging (MRI) or ultrasound. The latter studies can better show soft tissues like the cuff tendons and indicate the tear as well as where the tear is located.

How is it treated?
As bad as these injuries can be, the good news is that rotator cuff tears are treatable. Often the issue resolves on its own in time. Typically, I first recommend a conservative regimen that may include resting the joint as much as possible; icing the shoulder to reduce pain; physical therapy to strengthen the joint; or an anti-inflammatory painkiller. If the pain interferes with sleep, daily activities or exercise, I may recommend a steroid injection into the shoulder joint. If the problem persists, then surgery (shoulder arthroscopy) is an option, which is usually done on an outpatient basis.

Are there risks associated with the condition?
Because most rotator cuff tears are largely caused by the normal wear and tear that goes along with aging, people over 40 are at greater risk. Athletes are especially vulnerable, and people who do repetitive lifting or overhead activities are also at risk for rotator cuff tears. Although overuse tears caused by sports activity or overhead work are common in younger people, most tears in young adults are due to a traumatic injury, like a fall.