Rotator Cuff Tear

What a rotator cuff tear is

The rotator cuff is a group of four muscles that begin on the shoulder blade and end as flat tendons wrapping over the top and front of the humeral head. Their job is twofold. They rotate and elevate the arm, and just as importantly they hold the ball centered in its shallow socket so the much larger deltoid has something stable to pull against. When one tears, both functions are affected, which is why a cuff tear can produce weakness out of proportion to the size of the hole.

Tears are described by their thickness and their cause. A partial thickness tear involves part of the depth of the tendon; a full thickness tear passes all the way through, and if large the torn edge may pull back from the bone. Some tears are traumatic, following a fall onto an outstretched hand, a heavy lift or a dislocation. Many others are degenerative, developing quietly as tendon tissue changes with age and use. Degenerative tears can exist without pain, and can become painful after a minor event that would not have troubled a healthy tendon.

Symptoms that often bring people in

• Pain over the outer shoulder and upper arm, often where a shirt sleeve ends.
• Difficulty sleeping on the affected side, and pain that wakes you at night.
• Weakness lifting the arm to the side or overhead, or trouble holding it in position.
• Trouble reaching behind the back or into a coat sleeve.
• An arm that feels normal at rest but tires quickly during overhead work.

How it is evaluated

The history matters here, particularly whether there was a specific injury and whether the main complaint is pain, weakness or both. On examination the shoulder is inspected for muscle wasting, and motion is tested actively and passively. Individual strength tests isolate the different cuff tendons, because each has a position in which it can be examined on its own, and the pattern of weakness suggests which is involved. The examiner also assesses the biceps tendon and the neck, since nerve irritation there can mimic shoulder weakness. Plain X-rays do not show tendon, but they show the bony arch, spur formation and whether arthritis is present. MRI defines the location, thickness and extent of a tear along with the quality of the muscle.

Treatment options in general terms

Not every cuff tear requires repair, and non-surgical care is frequently the first path.

• Physical therapy. A structured program training the remaining cuff muscles and the shoulder blade stabilizers so the shoulder is well controlled despite the tear.
• Activity adjustment. Temporarily reducing overhead and heavy pulling tasks while the tendon is irritable.
• Medication categories. Anti-inflammatory or analgesic options discussed as part of symptom control.
• Injections. Corticosteroid injection above the tendon, or platelet rich plasma in selected situations.

Surgery may be considered when weakness is significant, when a tear is acute, or when symptoms persist despite non-surgical care.

• Arthroscopic repair. The torn tendon edge is brought back to its footprint on the bone and secured, through small incisions with a camera inside the joint.
• Debridement and decompression. Cleaning up frayed tissue and creating more room beneath the bony arch, sometimes chosen when a tear is not repairable.
• Reconstruction or arthroplasty. For long standing, retracted tears, tendon transfer or a reverse shoulder replacement may be raised, especially when arthritis has developed.

What to expect when you consult Dr. Wolfson

Dr. Wolfson is board certified in the United States and Canada and takes a conservative first approach where it is reasonable, reserving surgery for shoulders in which it is genuinely indicated. At a consultation he will examine each cuff tendon separately and explain what the tear pattern means for the options in front of you.

This page provides general information about rotator cuff tears and is not medical advice. It is not a substitute for examination, imaging and diagnosis by a qualified physician. Every case is different and requires individual evaluation. If you have severe pain, an obvious deformity, loss of function, fever, or an injury from a significant accident, seek medical care promptly.

Contact Dr. Wolfson if you would like to setup an appointment. If you are a new patient, please book all in-person appointments with Dr. Wolfson via telephone.

If you live outside of the San Francisco Bay Area, you can request a complimentary phone consultation with Dr. Wolfson to assess your case. Please call or e-mail us to set up your complimentary consultation.

Call: (415) 221-4400

E-mail: [email protected]