Among the most common orthopedic injuries, rotator cuff tears cause shoulder pain and temporary disability for millions of people each year. And while we associate rotator cuff injuries with baseball pitchers who are constantly putting strain on the shoulder, this problem is most often diagnosed in adults age 60 and older.
“Only about 8 to 10 percent of rotator cuff tears actually are caused by a traumatic event such as lifting overhead, falling, etc. In actuality, rotator cuff tears occur in the general population due to tendon degeneration caused by a multitude of factors,” says Dr. Jason Young, an orthopedic surgeon and sports medicine specialist with Orthopedic Associates.
The rotator cuff is composed of muscles and tendons that provide stability and facilitate movement in the shoulder. “The shoulder joint is more reliant on these muscles to function than many other joints because it’s a ball-and-socket joint with a very shallow socket, as compared to the hip, for example,” explains Dr. Scott Kaar, a SLUCare orthopedic surgeon and sports medicine specialist. “Over time, everyone gets wear and tear of the rotator cuff. It begins with inflammation or tendonitis, and progresses to rotator cuff partial tears and eventually full-thickness tears over many years.”
Many people have asymptomatic rotator cuff injuries that heal with time. However, more serious tears cause an aching pain in the shoulder and upper back that is made worse if the patient tries to elevate his or her arm. Many patients complain that the pain keeps them awake at night. Because symptoms may mimic other types of shoulder injuries or conditions, a physical exam is needed to diagnose rotator cuff injuries.
“Rotator cuff tears are not always a problem for patients. In fact, one study found that about 17 percent of asymptomatic people had rotator cuff tears found on imaging,” says Dr. Miho Tanaka, a Mercy orthopedic surgeon and associate team physician for the St. Louis Cardinals. Whether symptoms occur may have to do with inflammation in the shoulder and weakness of the surrounding muscles. Many people are able to compensate with other muscles and have almost full function and no pain despite the tear, she adds.
“For the most common tear types (non-traumatic tears that worsen over time), the goal of treatment is to treat the symptoms of pain and stiffness,” Kaar says. “If this can be achieved successfully with physical therapy exercises, cortisone injections, icing and medications, then that’s great. If those nonsurgical options don't work or stop working, then surgery becomes the next option.”
Rotator cuff surgery may be performed with an arthroscope, leaving only a tiny incision and speeding recovery. “There are theoretical advantages—less chance of infection and less muscle damage—with arthroscopic repair, though that hasn't really been documented in the research, so we can't say for sure if that's the case or not,” Kaar notes. Recovery involves keeping the arm in a sling for four to eight weeks followed by physical therapy to help strengthen the muscles and regain range of motion.
“Rotator cuff pain is very common in the general population, especially as the workforce ages,” Young notes. “If you experience pain with overhead work, weakness and night pain, it’s important to be evaluated by an orthopedic surgeon for further management.”