If you can’t comb your hair or lift your arm without pain, you might have a rotator cuff tear.
The word “tear” often confuses and scares people. You may automatically think of a snap, pop, or complete inability to move your arm.
Those things can happen with a large rotator cuff tear. The tendon can pull away from the bone if it’s a particularly severe tear. Your arm essentially becomes non-functional.
But many, many people have smaller rotator cuff tears that happen with wear and tear. And the good news is that many of these tears don’t need surgery.
So, if the phrase “rotator cuff tear” inspires a sense of deep dread, keep reading! It may not be nearly as dire as you think.
Rotator Cuff Anatomy: The ‘Brain’ of the Shoulder
Your rotator cuff works hard behind the scenes. When all is well, you can lift your arm and reach in all directions.
From reaching the top shelf to holding your arms out to your side, your rotator cuff is the mastermind behind the action. The rotator cuff is actually a group of 4 muscles that come together as tendons. They form a “cuff” that attaches your arm to your shoulder.
This cuff allows you to lift your arm away from your body and helps keep your arm bone in your shoulder socket.
Your rotator cuff is strong and resilient. But it’s also vulnerable to injury.
What Are the Causes of a Torn Rotator Cuff?
As you can imagine, your rotator cuff tendons are nearly always working. Over time, they can fray, tear slightly, or tear completely.
In fact, it might surprise you to learn that the most common cause of a torn rotator cuff is wear and tear. In terms of activities, repetitive motion — especially overhead motions — is often the culprit.
This is why it’s a common injury in racket sports. Also, daily overhead lifting can weaken the tendons and cause tears.
The other leading cause of a torn rotator cuff is an acute injury. If you have an acute injury, like a fall or an accident, one or more tendons can tear suddenly. For example, falling on an outstretched arm or lifting something heavy with a jerking motion can cause a tear.
What Does a Rotator Cuff Tear Feel Like?
Not all rotator cuff tears have symptoms, especially small ones. In fact, if you scanned everyone over the age of 80, most people would have at least a small tear. Many of those people wouldn’t know it.
The classic torn rotator cuff symptoms are:
- Pain and/or weakness when lifting your arm.
- Pain at night, especially if you’re lying on the shoulder that hurts.
- Pain when reaching up, out, or overhead.
- Feeling a cracking or popping sensation when you move your shoulder in certain ways.
Your symptoms might start out mild, bothering you only when you use the arm. At first, medicines like aspirin or ibuprofen may relieve the pain. But the pain can intensify, especially if you keep using the rotator cuff.
As for acute rotator cuff injuries, those tend to cause immediate pain and weakness in your arm.
Who Is Most Likely to Get a Rotator Cuff Tear?
You can tear your rotator cuff at any age, at any time. But you’re at higher risk if you:
- Are 40+ years old — Rotator cuff tears happen primarily because of wear and tear. The older you are, the more you’ve used your rotator cuff. With age, tendons also start to lose elasticity.
- Are an athlete — Certain sports put you at higher risk for injuring your rotator cuff. Think sports with repetitive arm and shoulder motions, like swimming, rowing, tennis, baseball, and squash.
- Have a labor-intensive job—People who work physically demanding jobs that require lifting heavy things often have rotator cuff issues. Jobs with repetitive motions, like painting or stocking, can also cause rotator cuff problems.
How Do You Treat a Torn Rotator Cuff?
About 80 to 85% of the time, nonsurgical treatment can help heal rotator cuff tears.
However, it can take time to heal a tear. There’s no express route or “quick fix” to heal a tear. Surgery can definitely treat large tears, but even surgery requires recovery time and physical therapy.
The main nonsurgical treatments for rotator cuff tears are:
- Rest. As difficult as this is, try avoiding the activity that is causing pain. That can mean taking a break from your sport and finding an alternative.
- Medicine. Anti-inflammatory drugs like aspirin, ibuprofen (Advil), and naproxen (Aleve) can help. Your doctor may also prescribe a stronger anti-inflammatory.
- Physical therapy. You can do specific PT exercises to improve your range of motion and strengthen your shoulder.
- Pain injection. If rest, medicine, and PT don’t work, your doctor may suggest a cortisone injection. Steroid injections work very well for some people and not as well for others. According to the American Academy of Orthopaedic Surgeons, about two-thirds of people have pain relief for at least three months.
If your symptoms last for more than six months, or you have a large tear, your doctor might suggest surgery. Surgery is also a good option for people whose livelihoods depend on their ability to use their arm for overhead work.
At UPMC, we work with people every day to help improve their pain and get back to the activities they enjoy. This includes helping heal rotator cuff tears. Learn more about how UPMC Orthopaedic Care can help.