Orthopaedic Conditons & Treatments

Rotator Cuff Tear, Symptoms and Causes

A rotator cuff tear is a partial or total split in the tendinous portion of the four muscles that connect the upper arm bone (known as the humerus) to the shoulder blade (known as the scapula). The head of the humerus is held securely but fluidly in the shoulder blade’s socket. This “ball-and-socket” joint must function correctly in order for you to do things that most people take for granted – like brushing your hair and putting on your pants – without pain (pain which is sometimes incapacitating). Rotator cuff tears affected nearly two million Americans in 2008 alone. Because chronic injury (i.e., damage done over a significant length of time) is the most prevalent type of the injury, rotator cuff tears are seen far more in people over 40.

A rotator cuff tear is the most commonly sustained sports injury – especially in baseball and swimming. Chronic rotator cuff tears are so common in swimmers that it is called “swimmer’s shoulder.” In baseball, pitchers are the players most likely to sustain chronic rotator cuff tears – because of the frequency with which they throw the ball. All players, though, are vulnerable to the injury. Acute rotator cuff tears are most frequently sustained because one has taken a fall with an arm extended or attempted to lift something with a non-fluid motion. Older people are the population most affected by acute rotator cuff tears as well as chronic rotator cuff tears, as their tendons are not as tough as they once were. As people age, their tendons wear away, and their blood supply becomes less plentiful – a situation that can make a minor fall traumatic.

Anatomy of the Shoulder

The shoulder, the joint in the human body with the greatest field of mobility, is composed of the following:

  • The clavicle (the collarbone)
  • The scapula (the shoulder blade)
  • The humerus (the upper arm bone)
  • The rotator cuff (four muscles that turn to tendon in order to push the humerus into the shoulder socket and give the arm rotational and lifting ability)
  • A bursa (a lubrication sac sitting between the humerus and the acromion, which is the technical name for the outward end of the shoulder blade) 

Types of Rotator Cuff Tear

Rotator Cuff Tears can be divided into two main types (you will notice that type I strains are missing; this is because type I strains are non-tearing strains):

  • Type II strain – Type II strains are partial tears of the rotator cuff.
  • Type III strain – Type III strains are total tears of the rotator cuff.

Causes of Rotator Cuff Tear

There are a few causes of rotator cuff tears. Some causes are associated with older people, some are associated mainly with younger people and some with people of all ages:

  • Acute injury – This is the least common cause of a tear. A fall from a great height or an attempt to lift a heavy object with lurching motions can cause an acute tear of the rotator cuff.
      
  • Chronic injury – The quite-tough rotator cuff is most often torn because it has been worn down. This wearing down is the result of repetitive stress put on it. This stress can be caused by arm motions associated with sports, such as weightlifting, tennis, rowing and baseball, or with occupations, such as carpentry.
     
  • Degenerative injury – As with all bodily injuries, older people are more vulnerable to rotator cuff tears. As with all muscles, the rotator cuff loses some of its vitality as people age. Additionally, the bone spurs that frequently form on the outward ends of older people’s shoulder blades wear on the rotator cuff. This causes the rotator cuff to weaken (a condition known as shoulder impingement) and become more liable to tear.
     

Symptoms of Rotator Cuff Tear

Different types of rotator cuff tears have different symptoms. Acute rotator cuff tears cause immediate, extreme pain and the loss of a significant amount of arm strength. Also, you may feel a “snap” in your shoulder because of an acute rotator cuff tear. Chronic tears, on the other hand, frequently start as mild pain, which may only be felt when executing a particular arm movement. As time goes by, though, this pain will become more diffuse, consistent and debilitating.

The following are common rotator cuff tear symptoms:

  • Pain
  • Weakness
  • Limited mobility
  • Shoulder cracking when it is put in certain positions

The symptoms of rotator cuff tears may be mistaken for the symptoms of other medical conditions (such as suprascapular neuropathy and subacromial impingement syndrome). Make sure you consult a doctor in order to determine if you have a rotator cuff tear and get the appropriate treatment. 

The multidisciplinary team of orthopaedic experts at North Shore-LIJ Orthopaedic Institute in New York treats Rotator Cuff Tears as well as a broad range of conditions that affect the bones within the body.

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