What is the Rotator Cuff?

The rotator cuff (commonly misspelled “rotator cup”, “rotary cuff”, “rotary cup” or “rotor cup”) is located at the top of the upper arm bone (also known as the head of the humerus bone). 

It consists of a collection of four muscles and their tendons as they connect to the upper part of the humerus bone. The muscles and tendons wrap around the shoulder joint, effectively covering the front, top and back side of the bone.

The muscles and tendons of the rotator cuff enable you to raise your arm, reach behind your back and carry your arm through the entire throwing motion. 

The most common injury to the rotator cuff involves swelling or tearing of the tendons near their attachment into the bone of the upper arm.  A rotator cuff tear can involve the actual attachment of the tendon into the bone and it can also extend past the tendon into the muscle itself.  

What is a Torn Rotator Cuff?

 A partial or complete rupture of one of the tendons of the 

rotator cuff is known as a rotator cuff tear or a torn rotator cuff. 

The tear can occur in one or a number of the tendons of the rotator cuff, with more severe rotator cuff tears involving more of the tendons. 

A torn rotator cuff can occur as a result of an injury or due to overuse/repetitive strain of the shoulder joint.  

In younger individuals a torn rotator cuff is more commonly due to an injury, especially in contact sports or sports which utilize a racquet or a club (such as golf or baseball).  In older individuals a rotator cuff tear is usually as a result of overuse or repetitive motion irritations.  

What are common symptoms of a rotator cuff tear?

A torn rotator cuff will often cause pain that you will feel throughout the shoulder region. 

It may not be localized to a particular point in the shoulder but will rather be uncomfortable with sharply increased pain when you move your arm in certain ways. 

More severe rotator cuff tears may produce pain down the upper arm and might also cause limitation in movement, especially when you try to raise your arm up to or over your head. 

Less severe rotator cuff tears or incomplete tears may only produce pain or pain and some weakness, but not noticeable limitation of movement. 

In any case, a complete diagnosis is your best course of action so that you can make the most informed decisions about proper treatment for your torn rotator cuff.

The common symptoms of rotator cuff tears are:

• Pain – Rotator cuff pain usually involves the outside of the shoulder and the upper arm, especially when you raise your arm up over the head.  Due to increased pressure and strain on the shoulder joint when you lay on your side or stomach, it is also common to notice rotator cuff pain increase at night.  The more significant the injury, the more likely the pain will increase and even wake you at night.  

• Weakness – As a rotator cuff tear involves the tendons of muscles which move your shoulder, when they become injured, your muscles lose the ability to move your arm with the same strength as they normally would.  As a result, certain movements become more difficult.  Special tests can be performed by a chiropractor or medical doctor to isolate the damaged tendon and determine the severity of the injury.  

• Limited Activity - Of course, if your rotator cuff tear is a result of repetitive use or overuse, the activities which caused your tear will also aggravate it; certain movements, especially those involving lifting your arm over your head or reaching back behind your body will be particularly challenging and painful.

Diagnosis of a rotator cuff injury can be made using specific tests to check muscle and joint strength and integrity in the case of complete tears. 

X-rays will often be taken to check for signs of a complete tear.  The tendons are not visible on x-ray, but the shoulder joint itself will appear differently when a complete rotator cuff tear has occurred.  

Partial rotator cuff tears, where the tendon is not completely severed, are more difficult to diagnose and may require more specialized tests such as an MRI of the shoulder.  Ultrasound is also becoming more commonly used to help diagnose and differentiate shoulder injuries.

What Is the Best Way to Treat a Rotator Cuff Tear?

Many times our bodies do a great job of healing problems all on their own.  Rotator cuff tears do not appear to be one of these times. 

Often, only using time as a healing technique for Rotator Cuff tears will lead to more problems, rather then fewer.  The tear will tend to increase without proper care and at best will remain the same.

The first objective in proper treatment of a rotator cuff tear is to isolate the cause of the tear, if possible.  If repetitive activity is at the cause of your injury, it will be necessary to avoid that activity for several weeks or months to allow for healing to occur. 

Often times a shoulder joint misalignment will occur as a result of or in conjunction with a rotator cuff tear.  Correcting the misalignment and maintaining proper alignment will improve the effectiveness of your healing process.

In addition to obtaining proper shoulder alignment and limiting your exposure to aggravating activities, physical therapy can help to strengthen the shoulder muscles and improve the function of your shoulder joint. 

Learning how to properly exercise and use your shoulder joint can also help to prevent future repeat episodes.  

Heat, especially moist heat, may provide some comfort if the shoulder is painful. 

Topical analgesics may also help, depending on the severity of the pain.

Use of oral pain relievers may help to reduce the symptoms associated with a rotator cuff tear, but it is important to carefully weigh out the risks versus benefits when looking to only alleviate symptoms.

Pain patches are also a great help, and are better than oral pain relievers because you do not have to worry about stomach upset or other side effects. Plus, they can be cut to fit the area and to maintain shoulder movement. 

Rotator cuff surgery may be necessary if the injury is either involving a younger individual experiencing significant loss of function or when more conservative methods do not achieve the results you are looking for. 

Rotator cuff tears can be repaired either through arthroscopic surgery or through more traditional open repair or mini-open repair, where a larger incision is made to access the tendons in the shoulder.  Through any of these methods, the surgery is usually relatively short, lasting about two hours but requiring four to six months for complete recovery.

With the exception of a traumatic rotator cuff tear in a younger person, which will typically involve surgery earlier, you will do best to choose conservative methods of treatment first while working towards more invasive treatments, such as medicine and surgery, as last resort.