Rotator Cuff Tear

A rotator cuff tear is a tear in one of the rotator cuff tendons: the supraspinatus most commonly, but on occasion the infraspinatus, subscapularis, and teres minor.  There are several different types of tears, from partial to full thickness to complete.  Tears are often referred to by location.  Bursal-sided tears refer to tears in the upper part of the tendon (that sits adjacent to the bursa) while articular-sided tears refer to tears on the bottom part of the tendon (that sits adjacent to the humeral head cartilage).

Causes

Causes of a rotator cuff injury may include falling, lifting and repetitive arm activities — especially those done overhead, such as throwing a baseball or placing items on overhead shelves.

Symptoms

A true complete rotator cuff tear will often be secondary to obvious trauma and a patient may hear a pop, have resultant significant pain, bruising, weakness and loss of motion.  Partial tears or chronic, atraumatic tears result from overuse and manifest as lateral shoulder pain that can radiate down to the elbow, typically worst at night. Pain and tenderness in your shoulder, especially when reaching overhead, reaching behind your back, lifting, pulling or sleeping on the affected side suggest rotator cuff involvement.

Procedures

Procedural options include cortisone injections to the subacromial bursa if the rotator cuff injury is bursal-sided, injections to the glenohumeral joint if the pathology is articular-sided. These injections help with pain but may actually weaken the tendon.  The relief may be temporary.  It can provide longer lasting relief if the condition is treated in conjunction with physical therapy.  The pain relief will allow for better participation in therapy. Regenerative-type injections (such as platelet-rich plasma [PRP] or stem cell injections) can theoretically provide longer lasting pain relief and improved function by stimulating the body’s own natural healing response.

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