A rotator cuff tear is a common cause of pain and disability among adults. In 2008, close to 2 million people in the United States went to their doctors because of a rotator cuff problem.
A torn rotator cuff will weaken your shoulder. This means that many daily activities, like combing your hair or getting dressed, may become painful and difficult to do.
Rotator Cuff Injury Causes
Injuries to muscle-tendon units are called strains and are classified by the amount of damage to the muscle or tendon fibers. Grade I strains involve stretching of the fibers without any tears. Grade II injuries involve partial muscle or tendon tearing, and grade III injuries are defined as a complete tear of a muscle or tendon.
The muscles and tendons in the rotator cuff group may be damaged in a variety of ways. Damage can occur from an acute injury (for example from a fall or accident), from chronic overuse (like throwing a ball or lifting), or from gradual degeneration of the muscle and tendon that can occur with aging.
- Acute rotator cuff tear
- This injury can develop from sudden powerful raising of the arm against resistance or in an attempt to cushion a fall (for example, heavy lifting or a fall on the shoulder).
- The injury requires a significant amount of force if person is younger than 30 years of age.
- Chronic tear
- Found among people in occupations or sports requiring excessive overhead activity (examples, painters, baseball pitchers)
- The chronic injuries may be a result of a previous acute injury that has caused a structural problem within the shoulder and affected the rotator cuff anatomy or function (for example, bone spurs that impinge upon a muscle or tendon causing inflammation).
- Repetitive trauma to the muscle by everyday movement of the shoulder
- Degeneration (wearing out) of the muscles with age
- This usually occurs where the tendon attaches to bone. The area has poor blood supply and a mild injury may take a long time to heal and potentially lead to a secondary tear.
Rotator Cuff Injury Symptoms
Symptoms of a rotator cuff injury are due to the inflammation that accompanies the strain. This inflammation causes swelling, leading to the clinical picture of pain and decreased range of motion. Because the muscles and tendons of the rotator cuff are hidden well below skin level, it may be hard to feel the swelling that accompanies the injury, but that swelling within the small space that makes up the shoulder joint prevents the normal range of motion of the shoulder joint.
- Acute rotator cuff tear
- Symptoms can be a sudden tearing sensation followed by severe pain shooting from the upper shoulder area (both in front and in back) down the arm toward the elbow. There is decreased range of motion of the shoulder because of pain and muscle spasm.
- Acute pain from bleeding and muscle spasm: This may resolve in a few days.
- Large tears may cause the inability abduct the arm (raise it out to the side) due to significant pain and loss of muscle power.
- Chronic rotator cuff tear
- Pain usually is worse at night and may interfere with sleep.
- Gradual weakness and decreased shoulder motion develop as the pain worsens.
- Decrease in the ability to abduct the arm or move it out to the side. This allows the arm to be used for most activities but the affected person is unable to use the injured arm for activities that entail lifting the arm as high as or higher than the shoulder to the front or side.
- Rotator cuff tendinitis
- More common in women 35-50 years of age
- Deep ache in the shoulder also felt on the outside upper arm over the deltoid muscle
- Point tenderness may be appreciated over the area that is injured
- Pain comes on gradually and becomes worse with lifting the arm to the side (abduction) or turning it inward (internal rotation)
- May lead to a chronic tear: When a rotator cuff tendon becomes inflamed (tend=tendon +itis=inflammation), it runs the risk of losing its blood supply, causing some tendon fibers to die. This increases the risk that the tendon can fray and partially or completely tear.
When to call the doctor
Not all shoulder pain arises from the shoulder. Sometimes pain from the heart can be referred to the shoulder, and pain from the gallbladder or diaphragm can also be felt in the shoulder region. Pain from a rotator cuff injury is worsened with shoulder movement.
- If the shoulder pain persists in spite of home care with rest, ice and if tolerated, anti-inflammatory medications
- If shoulder problems (pain) prevent the person from performing routine daily activities or work
- If pain prevents overhead reaching (for example, reaching to get an item in a cabinet above shoulder level)
- If the pain prevents playing sports in which an overhead motion is required (for example, throwing, swinging a racquet, or swimming)
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