Rotator cuff tears can cause nagging, aching pain that limits daily activities. A rotator cuff becomes torn when one of the tendons is injured. The tendon no longer attaches properly to the top of the humerus, or upper arm bone. The most common tear is in the supraspinatus muscle and tendon. This can cause an inflammation of the acromion, which may cause additional pain. There are several types of tears: partial, full-thickness, acute and degenerative.
The causes of these tears are most often an injury resulting from lifting something too heavy over-head, or repetitive stress. A lack of blood supply to the area, caused with age, can also reduce the body’s natural ability to repair itself. If a tendon is already slightly injured and the blood supply is diminished, a tear can occur. Most rotator cuff tears are caused from a combination of repetitive and degenerative causes. People age 40 and older are most at risk.
Symptoms include: pain if lying on the shoulder at rest, or when lifting and lowering the arm; weakness in the limb, especially when rotating the arm; or a crackling noise when moving the arm. When a tear is caused from a sudden injury, such as falling off a ladder or a car accident, there may be a snapping noise, followed by intense pain and a weakness in the arm.
A pain physician will rule out arthritis and a pinched nerve during examination. An MRI and ultrasound will likely be ordered to confirm the tear diagnosis. The MRI should provide the size and location of the tear.
Non-surgical treatment for rotator cuff tears include: rest, avoiding activities that cause pain, nonsteroidal anti-inflammatory over the counter medications, physical therapy and steroid injections. Half of all rotator cuff tear patients report pain relief without surgery. If a patient’s pain doesn’t improve, the physician may recommend surgery to repair the tendon and tear.