Torn Rotator Cuff

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Introduction

What is torn rotator cuff?

Torn rotator cuff refers to damage to one of the four muscles that allow the arm to rotate at the shoulder. Rotator cuff tears can also affect the tendons that hold these muscles together. Generally, a torn rotator cuff is the result of repetitive use, but it can occur as a single traumatic injury.

Rotator cuff tears are most common in older people who repeatedly perform activities with overhead motions, but they can occur in anyone. If you have a torn rotator cuff, you may experience muscle weakness, pain in the arm or shoulder, muscle wasting, or a crackling feeling when you move your shoulder. The pain may get worse with time.

There are many treatments for rotator cuff tears, depending on the severity. In mild cases, the tear may repair itself over time, and rest, over-the-counter medication, and exercise may speed healing. Physical therapy, prescription medications, and steroids may be necessary in more serious cases, while severe cases of torn rotator cuff may require surgery.

Surgery for torn rotator cuff ranges from smoothing of the tissues (debridement) to full tendon transfer (replacement of muscles or tendons). A combination of surgery and physical therapy often leads to greater recovery.

Seek immediate medical care (call 911) if you experience a snapping sound or sensation in your arm, coupled with intense pain and an inability to rotate your arm, as this may indicate that your rotator cuff has torn.

Seek prompt medical care if you are being treated for a torn rotator cuff and experience persistent or bothersome pain, or if your condition interferes with your daily life.

Symptoms

What are the symptoms of torn rotator cuff?

Symptoms of torn rotator cuff include pain, an inability to move the shoulder, and swelling.

Common symptoms of torn rotator cuff

You may experience torn rotator cuff symptoms daily or just once in a while. At times any of these symptoms can be severe:

  • Crackling sensation or sound when moving the arm or shoulder (crepitus)
  • Difficulty moving the arm or shoulder
  • Muscle wasting (atrophy)
  • Muscle weakness in the arm or shoulder
  • Redness, warmth or swelling of the shoulder
  • Reduced shoulder range of motion
  • Shoulder or arm pain

Symptoms that might indicate a serious condition

In some cases, torn rotator cuff can be a serious condition that should be evaluated immediately in an emergency setting. Seek immediate medical care (call 911) if you, or someone you are with, have any of these serious symptoms including:

  • Inability to rotate your arm
  • Intense electrical sensation shooting down the arm
  • Snapping sound or feeling in the shoulder
  • Sudden, intense shoulder pain, especially it if occurs during physical activity
  • Weakness in the muscles of the hand or arm
Causes

What causes torn rotator cuff?

Torn rotator cuff can be an acute (sudden) injury or a repetitive use (gradual) injury. Acute injuries may occur during strenuous activities, such as heavy lifting or sports, or may be due to an accident. More commonly, the rotator cuff will tear as a result of repetitive use, such as with frequent overhead lifting. In these cases, the muscles or tendons of the rotator cuff develop wear and tear over time. Athletes who frequently engage their rotator cuff, such as baseball players, have an increased risk of injury.

What are the risk factors for torn rotator cuff?

A number of factors increase the risk of developing torn rotator cuff. Not all people with risk factors will get torn rotator cuff. Risk factors for torn rotator cuff include:

  • Age older than 40 years

  • Chronic inflammation of the shoulder such as bursitis (inflammation of a bursa sac that cushions a joint)

  • Excessive strain on the shoulder joint

  • Frequent overhead lifting such as for a job

  • Impingement syndrome of the rotator cuff

  • Participation in certain throwing sports, such as baseball

  • Weak muscles or tendons

Reducing your risk of torn rotator cuff

Torn rotator cuff is most frequently a repetitive use injury and, thus, is often preventable. You may be able to lower your risk of torn rotator cuff by:

  • Avoiding activities that put excessive strain on your shoulder

  • Avoiding frequent, strenuous lifting

  • Avoiding sports that require frequent use of your shoulder joints, such as baseball or rowing

  • Regularly exercising your arm and shoulder muscles

  • Stretching your shoulders before and during exercise

  • Using a team of people to lift heavy objects

  • Using machinery to lift heavy objects

Treatments

How is torn rotator cuff treated?

A torn rotator cuff may heal on its own but can benefit from pain management, reducing inflammation, and physical therapy. If the tear is small and not excessively painful, treatments that include rest, a sling, and anti-inflammatory medications may be adequate for improving shoulder function. More serious cases of torn rotator cuff may require surgery.

Surgery for torn rotator cuff

Rotator cuff surgery is often an outpatient procedure. Advances in medical science have made minimally invasive (arthroscopic) surgery possible, although large rotator cuff tears may still require open surgery. Surgeries to treat torn rotator cuff include:

  • Debridement of injured tissues
  • Full replacement of the shoulder joint
  • Surgery to repair the torn rotator cuff

Other treatments for torn rotator cuff

In addition to surgery, or in cases where the tear is not severe, other treatments for torn rotator cuff may improve shoulder function. Such treatments include:

  • Anti-inflammatory medications
  • Pain medications
  • Physical therapy
  • Rest
  • Steroid medications
  • Supportive sling

What you can do to improve your torn rotator cuff

You may be able to improve the outcome of your torn rotator cuff treatment by:

  • Doing the shoulder exercises as prescribed by your physician or physical therapist
  • Resting your shoulder if it is in pain
  • Stretching your shoulder
  • Taking over-the-counter pain medications
  • Using hot or cold compresses

Complementary treatments

Some complementary treatments may help some people in their efforts to deal with torn rotator cuff. These treatments, sometimes referred to as alternative therapies, are used in conjunction with traditional medical treatments. Complementary treatments are not meant to substitute for traditional medical care. Be sure to notify your doctor if you are consuming nutritional supplements or homeopathic (nonprescription) remedies as they may interact with the prescribed medical therapy.

Complementary treatments may include:

  • Acupuncture
  • Massage therapy
  • Nutritional dietary supplements, herbal remedies, tea beverages, and similar products
  • Yoga

What are the potential complications of torn rotator cuff?

After experiencing a torn rotator cuff, it is important to maintain joint mobility in order to prevent complications. Complications of untreated or poorly controlled torn rotator cuff can be serious. You can help minimize your risk of serious complications by following the treatment plan you and your health care professional design specifically for you. Complications of torn rotator cuff include:

  • Adverse effects of treatment
  • Inability to participate normally in activities
  • Inability to perform daily tasks
  • Joint deformity and destruction
  • Progression of injury
  • Severe discomfort or pain
  • Tendon retraction
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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2018 Dec 30
  1. Rotator cuff tears. AAOS: American Academy of Orthopaedic Surgeons. http://orthoinfo.aaos.org/topic.cfm?topic=a00064
  2. Rotator cuff problems. Medline Plus, a service of the National Library of Medicine National Institutes of Health. http://www.nlm.nih.gov/medlineplus/ency/article/000438.htm
  3. Sørensen AK, Bak K, Krarup AL, et al. Acute rotator cuff tear: do we miss the early diagnosis? A prospective study showing a high incidence of rotator cuff tears after shoulder trauma. J Shoulder Elbow Surg 2007; 16:174
  4. Moosmayer S, Smith HJ, Tariq R, Larmo A. Prevalence and characteristics of asymptomatic tears of the rotator cuff: an ultrasonographic and clinical study. J Bone Joint Surg Br 2009; 91:196
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