Rotator cuff tears are a common source of shoulder pain and are one of the main reasons patients seek the care of an orthopaedic surgeon.

The rotator cuff is made up of four muscles and their tendons. These originate on the shoulder blade and combine to form a “cuff” over the upper end of the arm, inserting as a common tendon unit on the ball or head of the humerus bone.

The rotator cuff helps to lift and rotate the arm and helps to stabilize the ball of the shoulder within the joint.

While tears of the rotator cuff tendon can occur from a single, one-time injury, most tears occur due to degeneration of the tendon, related to the normal aging process over time. With aging, the blood supply to the rotator cuff diminishes, contributing to tendon degeneration and making the tendon less able to heal itself. Over time, this process can lead to an eventual full-thickness tear of the tendon.

Symptoms of pain usually develop gradually and may be caused or worsened by repetitive overhead activity. Pain is commonly felt over the front and or side of the shoulder and may radiate down the side of the arm toward the elbow. Pain is often present at night while sleeping and may be worsened when lying on the affected side. Other symptoms may include stiffness, loss of motion, or weakness of the shoulder if the tear involves a significant portion of the tendon. There may be difficulty using the arm to reach overhead or difficulty placing the arm behind the back.

Rotator cuff tears are usually diagnosed based on symptoms and a doctor's careful examination. Plain X-rays are usually normal or may show a small bone spur. MRI's are commonly performed and can show if a tear is partial or full thickness, as well as the size and extent of the tear. MRI's are also helpful to show if there is any other problem in the shoulder which may be responsible for the pain.

Once a diagnosis of a rotator cuff tear is made, several treatment options exist to provide pain relief and improve the function of the shoulder. These include rest and limited overhead activity, anti-inflammatory medication, steroid injection, physical therapy, and, finally, surgical repair of the torn tendon.

Surgery may be recommended if non-operative treatment does not relieve the symptoms. Surgery may also be considered if the tear is acute and painful, if it involves the dominant arm of an active individual, or if maximum strength is needed for overhead work or sporting activities.

While traditionally performed through an open incision, rotator cuff surgery can now be commonly performed using an all-arthroscopic technique or an arthroscopically-assisted mini-open technique. Most surgical repairs are done on an outpatient basis.

After surgery, the arm is temporarily immobilized to allow the tear to heal. Physical therapy is then usually required to regain motion and strength in the shoulder. Complete recovery may take several months, after which time most patients achieve excellent results.