Rotator Cuff Tear
It is estimated 2 million Americans visit their physician annually for rotator cuff tears. Such an injury can cause nagging, aching pain that limits daily activities; don’t think professional baseball — although pitchers are prone to such injury. Think the average Joe who has to wince his way through pulling a shirt over his head, or raising his arm to comb his hair.
The rotator cuff is made of four muscles, joined by tendons, that cover the head of the humerus bone. The cuff attaches this humerus — or upper arm bone — to the shoulder blade. Between these bones and the cuff is a lubricating sac called the acromion. It keeps bone from rubbing on bone. The shoulder is a ball and socket joint, allowing your arm to move around in circles, instead of just forward or backward.
A rotator cuff becomes torn when one of the tendons is injured. The tendon no longer attaches properly to the top of the humerus 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 likely injury — often from lifting something too heavy over head, or repetitive stress. Think again about that professional baseball pitcher. Throwing the ball over and over again can wear away the tendons, causing a rotator cuff tear.
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; those age 40 and older are most at risk.
Degenerative 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. The physician will have the patient move the arm in specific directions to determine the source of the pain, and may test for arm strength. X-rays are unable to show soft tissue, so an MRI and ultrasound will likely be ordered to confirm the tear diagnosis. The MRI should provide the size and location of the tear, and the physician may be able to determine from the image how old the injury is.
Non-surgical treatment for rotator cuff tears include: rest, avoiding activities that cause pain, nonsteroidal anti-inflammatory over the counter medications, like Aleve, physical therapy and steroid injections. Half of all rotator cuff tear patients report pain relief without surgery; however these options do not improve the strength of the shoulder — the only minimize pain. If a patient’s pain doesn’t improve, the physician may recommend surgery to repair the tendon and tear.