Rotator Cuff Tears Part I: Diagnosis and Evaluation

Intact Rotator Cuff.  Luis M. Espinoza, M.D. is a Double Board Certified Orthopedic Surgeon practicing at the OCSM.  Dr. Espi

The rotator cuff is a series of four tendons that forms a hood which attaches to the humeral head of the shoulder joint. Together they act in concert to help keep the humeral head (ball) stabilized in the glenoid (socket) and rotate the shoulder to position the arm for various athletic and everyday activities. The mere process of raising your arm over your head requires a significant amount of muscular coordination and necessitates having integrity of the tendons about the shoulder. If any of these tendons are damaged, there can be pain that severely limits the shoulder’s ability to function.

Rotator cuff tendons can be injured and torn by excessive force, such as trying to catch a heavy falling object, or lifting an object with the arm extended. Typically, a rotator cuff tear occurs in the late to middle-aged person who may or may not have been having problems with the shoulder preceding the acute event. That person starts a lifting activity that exceeds the strength of the tendons, and the tendon tears acutely, leaving an inability to raise the arm. There may or may not be pain associated with the event.

The incidence of rotator cuff tendon defects has been described in a number of studies and has been reported to occur in as low as six percent of people under the age of thirty and as high as thirty percent in people over the age of forty years. It has been concluded that rotator cuff defects become increasingly common after the age of forty and although many of these tears start out involving a small portion of the tendon (partial rotator cuff tear), they are likely to progress with increasing age and can eventually involve the entire tendon (complete rotator cuff tear).

In partial rotator cuff tear cases, you may experience pain but can continue to move the arm within a normal range of motion. In some cases, people with partial tears are able to compensate for their pain and manage fairly well despite having a rotator cuff tear, for example, the Chicago Cubs closing pitcher Joe Borowski was placed on the disable list on June 5, 2004 after being diagnosed with a torn rotator cuff in his pitching arm. Borowski had been struggling since spring training and his pitching velocity never topped 88 mph after hitting 94 mph speeds previously. Despite the partial tear, Borowski was able to pitch in 20 games before his injury came to light.

In the most severe case, a complete rupture of the tendon, you are unable to move the arm within a normal range of motion and often experience a significant loss of shoulder strength. Most rotator cuff tears cause a vague pain in the shoulder area, and may result in a “catching” sensation when the arm is moved. The larger the tear in the tendon, the more weakness there is when trying to move the arm. Most people report an inability to sleep on the affected side due to pain.

The physical examination is very important in diagnosing a rotator cuff tear. A complete tear is usually very obvious. If your doctor can move the arm in a normal range of motion, but you are unable to move the arm using your own strength, there is a high likelihood of a tear in all the tendons. Usually only one or two tendons are torn, and you will have weakness in the shoulder, but you may still be able to partially move the arm.

Initial treatment for a suspected rotator cuff tear is rest and anti-inflammatory medication to control pain. While a rotator cuff tear will not heal, some partial tears will become very tolerable and may not require a surgical repair. As soon as pain tolerance permits, physical therapy to regain motion is begun. A cortisone injection may be suggested if you are still having pain after several weeks of non-operative care.

X-rays can also give clues that there is a rotator cuff tear. After a reasonable time, if the pain is not tolerable or the motion of the arm is not acceptable, an MRI scan may be suggested as a diagnostic tool to plan for surgery.

Surgery to repair a tear of the rotator cuff tendons is necessary if there is a complete tear in one or more of the rotator cuff tendons. Surgery may also be necessary for a partial tear of the tendons if the tear causes persistent pain and difficulty with overhead activity.

Author
Luis M. Espinoza MD Dr. Espinoza served as the AAA Team Doctor for the the New Orleans Zephyrs/BabyCakes since joining the Orthopedic Center for Sports Medicine in 2003. He is double board certified in General Orthopedic Surgery and Sports Medicine.

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