Rotator Cuff Tears Treatment

The rotator cuff is made up of four muscles and their tendons that encircle the shoulder joint, providing stability and ensuring the head of the upper arm bone remains securely within the shoulder’s shallow socket.  Rotator cuff tears occur when tendons pull away from the arm bone resulting in compromised shoulder function, causing pain and weakness significantly impact one’s ability to perform daily tasks and enjoy physical activities.

Rotator cuff tears are a prevalent source of shoulder pain and disability, affecting individuals across various age groups and activity levels.

Cuban orthopaedics are highly skilled and proficient in treating rotator cuff tears mainly with conservative measures such as physical therapy and steroid injections and when necessary, surgical intervention.  The goal of treatment is to alleviate pain, restore shoulder function, and improve the patient’s overall quality of life. Left untreated, rotator cuff tear can lead to:

• Permanent loss of motion.
• Weakness of the shoulder joint.
• Increased pain.
• Shoulder stiffness.
• Tendon degeneration.
• Increased risk of arthritis.
• Compensatory injuries.
• Reduced quality of life.

Types of Rotator Cuff Tears:

There are two main types of rotator cuff tears, categorized based on the nature and extent of the injury:

• Partial Thickness Tears: Also known as an incomplete tear, this type of tear occurs when the tendon is damaged but not completely detached from the bone leaving some level of tendon continuity.

• Full Thickness Tears: Also known as a complete tear, involves a complete rupture of the tendon. In these tears, the tendon is entirely severed, leaving a full gap between the torn edges of the tendon.

Full thickness tears can further be classified based on their size and the extent of tendon involvement:

• Small Tears: Less than 1 centimeter (about 0.39 in) in size.
• Medium Tears: Between 1 and 3 centimeters (about 1.18 in) in size.
• Large Tears: Between 3 and 5 centimeters (about 1.97 in) in size.
• Massive Tears: Greater than 5 centimeters (about 1.97 in) or involving more than one tendon.

Rotator cuff tears can also be categorized based on their cause:

• Traumatic Tears: Also referred to as acute tears, these tears occur suddenly due to an acute injury, such as falling on an outstretched arm, lifting a heavy object, or experiencing a sudden, forceful movement. This type of tear can occur with other injuries, such as a broken collarbone, a dislocated shoulder, or a wrist fracture.

• Degenerative Tears: These tears develop gradually over time due to wear and tear and are more common in the dominant arm. If there is a degenerative tear in one shoulder, the likelihood of a rotator cuff tear in the opposite shoulder increases, even if there is no pain in that shoulder.

Causes of Rotator Cuff Tears

The following factors may increase the risk of having a rotator cuff injury:

• Age: Most rotator cuff injuries are often caused by the natural age-related progression wear and tear of the tendon tissue

• Bone spurs: Bony growths can develop on the top of the shoulder bone and rub against the tendon when the arm is lifted. This shoulder impingement creates friction between the bone and tendon, which can eventually lead to a partial or complete tear.

• Decreased blood flow: Reduction of blood flow to the rotator due to aging can significantly contribute to the development of rotator cuff tears. When the tendons receive insufficient blood supply, their ability to repair and maintain themselves diminishes, leading to weakening and degeneration over time. This compromised state makes the tendons more susceptible to tears

• Overuse: Repetitive shoulder movements during sports or on the job can stress the muscles and tendons, causing a tear.

While overuse of tears from sports activity or overhead work can occur in younger individuals, most rotator cuff tears in young adults result from traumatic injuries, such as falls.

Symptoms of Rotator Cuff Tears

Common symptoms of rotator cuff tear include:

• Shoulder pain, especially during overhead activities or while at rest
• Difficulty lifting or rotating the arm due to muscle weakness.
• Limited range of motion
• Stiffness
• Clicking or popping sensations
• Muscle atrophy

Diagnosis of Rotator Cuff Tears

Diagnosis of rotator cuff tear is generally based on physical examination and imaging tests are recommended to rule out other conditions with similar symptoms:

• Medical history review: A comprehensive medical history, encompassing questions about the onset and duration of symptoms, as well as any family history of similar conditions.

• Physical examination: This includes a thorough assessment of the shoulder’s range of motion, strength, stability, overall function and look for any visible deformities or muscle atrophy. Additionally, the neck and other nearby areas will be examined to rule out other conditions that could mimic rotator cuff injuries.

• X-rays: While a rotator cuff tear itself won’t be visible on an X-ray, this test helps rule out other potential causes of pain, such as bone spurs.

• Ultrasound: Sound waves produce images of muscles and tendons, allowing assessment of shoulder structures during movement.

• Magnetic Resonance Imaging (MRI): Detailed images of the shoulder are obtained using MRI to reveal the quality of the rotator cuff muscles, the rotator cuff tear, as well as where it is located within the tendon and the size of the tear. An MRI can also show how old or new a tear is.

Treatment Options for Rotator Cuff Tears

Treatment for rotator cuff tear involves reducing inflammation, strengthening the surrounding muscles, and enhancing the range of motion. Treatment typically is with conservative (non-surgical) treatment and surgical treatment.  The decision between non-surgical and surgical options is guided by several factors, including:

• Severity and size of the tear
• Patient’s age, activity level, and overall health
• Presence of any other medical conditions
• Patient’s pain level
• Impact of the tear on daily activities
• Response to initial non-surgical treatments

Non-surgical Options

Treatment for rotator cuff tear usually begins with nonsurgical methods include:

• An arm sling and rest: To give the shoulder time to heal. You may need to modify

• Activity modification: Avoiding activities that cause shoulder pain and stopping certain work or sports for a while.

• Nonsteroidal anti-inflammatory drugs (NSAIDs): to minimize pain and swelling.  

• Steroid injection: Cortisone is injected into the shoulder joint, especially when the pain is interfering with sleep or daily activities or physical therapy.

• Physical therapy: This is a key component in the treatment of a rotator cuff tear, aiming to restore function, reduce pain, and improve strength and flexibility. Included are:

• • Pain management and inflammation reduction
  • Pendulum exercises.
  • Passive range of motion exercises
  • Overhead stretch exercises.
  • Strengthening exercises.
  • Functional training
  • Activity-specific exercises.
  • Proprioception exercises.

Surgical Options

In cases where non-surgical methods are insufficient, surgery may be recommended to repair the torn tendon and restore the structural integrity of the shoulder. Surgery may also be recommended when:

• When symptoms have lasted 6 to 12 months
• When the tear is more than 3 cm and the quality of the surrounding tendon tissue is good
• When there is weakness and loss of function in shoulder
• The tear was caused by a recent, acute injury

There are several options for repairing rotator cuff tears. Although each method has its own advantages and disadvantages, they all share the same goal of promoting the healing of the tendon back to the bone.

• Arthroscopic tendon repair: In this procedure, a small incisions are made, and a camera (arthroscope) is used to guide small instruments to repair the tea by reattaching to the bone, and to remove any damaged tissue.

• Open tendon repair: This is a traditional open surgery to repair large or complex tears. The surgeon makes an incision over the shoulder and either detaches or splits part of the deltoid muscle to gain better visibility and access to the torn tendon.

• During an open repair, the surgeon usually removes bone spurs from the underside of the acromion

• Tendon transfer: This procedure is carried out when the torn tendon is too damaged to be reattached to the arm bone. It involves using an nearby tendon, often from the upper back, as a replacement.

• Shoulder replacement: This procedure is for severe rotator cuff injuries and involves replacing the damaged shoulder joint with a prosthetic implant.