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Donald D. Berg, M.D. P.C.
Orthopedic and Reconstructive Surgery
 Sports Medicine
The Practice of Orthopedics

Serving Southeast Iowa Since 1975

Rotator Cuff Tear

The rotator cuff is composed of four muscles:  the supraspinatus, the infraspinatus, the subscapularis and the teres minor muscles.

These muscles form a cover around the head of the humerus whose function is to rotate the arm and stabilize the shoulder joint in its socket.

Rotator cuff tears occur primarily in the supraspinatus tendon, which is weakened as a result of many factors, including injury, age poor blood supply to the tendon and subacromial impingement.  This injury, rarely affects people younger than 40 years.

Diagnosis

You will be required to have the following tests to confirm a rotator cuff tear to rule out rotator cuff tendonitis or rupture;  an x-ray or a shoulder arthrogram.  This test is more cost-effective and as accurate as an MRI scan and will confirm the diagnosis.

Treatment

Conservative treatment includes non-steroidal anti-inflammatory drugs (NSAIDs), physical therapy with strengthening and stretching exercises, subacromial corticosteroid injections and avoiding overhead activities.  Corticosteroid injections are controversial, as there is not evidence that they help the tendon to heal.  While corticosteroids do relieve pain in the short term, repeated injections tend to weaken the tendon and may ultimately lead to the need for surgical repair.  Therefore, patients should not receive more than three subacromial injections.

Complete cuff tears require surgery.  Just as the ends of a rubber band stretched between two sticks will retract when cut, so, too will a torn rotator cuff retract when the tendon is ruptured.  However, not all patients have severe enough symptoms that they want to undergo surgery.  Patients with acute rotator cuff tears tend to do better if they undergo surgery within 6 weeks of the time of the injury.

Clinical Symptoms

Patients often report recurrent shoulder pain for several months and can often pinpoint a specific injury that triggered the onset of the pain.  Night pain is characteristic and patients often report having difficulty sleeping on the affected side.  Weakness, catching and grating are common symptoms, especially when lifting the arm overhead.

The shoulder may appear sunken, indicating atrophy of the supraspinatus and infraspinatus muscles.  This appearance is common in long standing rotator cuff tears.  With large tears, the patient can only shrug or "hike", the shoulder when asked to lift the arm.

                                  Last Updated June 21, 2010  

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