What is a rotator cuff tear?

Anyone who's felt it knows the ache all too well. It’s that deep, nagging shoulder pain that makes reaching for a coffee mug feel like a workout.

Shoulder pain leads to roughly 4.5 million medical visits annually in the U.S. Rotator cuff tears are among the leading causes.

Dr. Jonathan Myer, a board-certified orthopedic surgeon and sports medicine doctor with Sharp Community Medical Group and affiliated with Sharp Grossmont Hospital, breaks down what you need to know.

What is the rotator cuff?

Think of the rotator cuff as your shoulder's built-in support system — a group of muscles and tendons that wrap around the shoulder joint and anchor your upper arm to your shoulder blade. Together, the rotator cuff muscles and tendons help stabilize the shoulder and allow you to lift, reach and rotate your arm.

With repetitive stress, aging or a sudden injury, the tendons can fray, swell or tear. A sudden, forceful injury can even tear a tendon off the bone or split it in the middle. Acute tears can come from injuries like a fall or suddenly lifting something heavy.

However, most tears aren't dramatic. They develop from degeneration, a gradual breakdown of the tendon that builds quietly over years, driven by aging and vascular and metabolic factors.

What are the symptoms of a rotator cuff tear?

Along with pain in the shoulder that may extend into the upper arm, symptoms of a rotator cuff tear include:

• Weakness when lifting or rotating the arm

• Trouble moving the shoulder, especially lifting your arm overhead

• A “snapping” or “crackling” sensation or noise when you move it

• Pain that makes it difficult to sleep on the affected side

How is a torn rotator cuff diagnosed?

To gauge your shoulder's range of motion, your doctor will have you move your arm in several directions and test its strength. They will also rule out other common shoulder pain culprits, such as arthritis or frozen shoulder.

From there, imaging — X-rays, MRI or ultrasound — can help confirm the diagnosis. When additional imaging is needed, MRI is often preferred because it shows tendons, cartilage and bone. This helps determine what's torn and the extent of the injury, which can help guide treatment decisions.

How is a torn rotator cuff treated?

Many rotator cuff tears become less symptomatic over time, particularly with appropriate nonsurgical treatment. Patients often experience a meaningful reduction in pain and improved shoulder function with supervised physical therapy.

If pain is interfering with sleep or daily activities, a corticosteroid injection may be considered in selected cases.

If symptoms persist despite appropriate non-surgical care, surgery — usually a minimally invasive shoulder arthroscopy performed on an outpatient basis — may reduce pain, improve function and help you return to the activities that matter most to you.

How is treatment chosen?

Together with your doctor, you will weigh factors, such as age, tear size, demand on the shoulder and, crucially, how your shoulder responds to an appropriate trial of nonsurgical treatment. For many people, especially older adults with smaller, wear-and-tear tears, that conservative path is sufficient.

Surgical repair may be considered for younger, active patients; patients with acute traumatic tears; and those whose symptoms persist despite appropriate nonsurgical treatment.

If shoulder pain is limiting your daily activities, the Sharp Sports Medicine Clinic offers comprehensive care for rotator cuff injuries and other shoulder conditions, with treatment plans tailored to each patient's needs and goals.

Who is at risk for rotator cuff tears?

Because many rotator cuff tears develop gradually with age-related tendon degeneration, your risk increases after the age of 40.

Roughly 13% of people in their 50s, 20% in their 60s, and 31% in their 70s have a tear. Many adults over 60 have evidence of a partial or complete tear on imaging, often without symptoms.

Athletes who participate in repetitive overhead activities may also be at higher risk, as may anyone who does repetitive lifting or overhead work. And while overuse tears from sports or overhead jobs do happen in younger people, most tears in younger adults are likely to result from a traumatic injury, such as a fall or sudden forceful movement.

Talk with your doctor if you are experiencing shoulder pain. Together, you can determine the best diagnostic and treatment options for you.

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