Rotator cuff tendon tears are a common cause of shoulder pain and affect millions of people each year. Most people associate tendon tears with sports injuries or injuries in young people, but the majority of rotator cuff tendon tears occur gradually with age, as people perform the same overhead tasks again and again. In fact, some studies have shown that 30% of people over the age of 70 years have a rotator cuff tendon tear. Luckily, not all rotator cuff tears are painful.
There are four rotator cuff tendons that surround the ball of the shoulder joint. Their primary purpose is to control shoulder rotation, although they also keep the ball of the joint centered in the shallow cup of the joint. The shoulder joint is much more flexible than the other joints in your body, such as your hips and knees. So while other joints can depend on the shape of the bones in order to function properly, the shoulder depends on the muscles and tendons in order to work correctly and maintain flexibility. As a result, rotator cuff tendons are more prone to injury than the tendons in your other joints.
The most commonly torn rotator cuff tendon is the supraspinatus tendon, which is the tendon on the top of the shoulder joint. When this tendon tears, it can cause pain in the front and on the side of the shoulder. The pain often spreads down the arm, and it can even feel like the middle of the arm is injured, rather than the shoulder. When the supraspinatus tendon is torn, reaching overhead, to the side, and behind the back becomes painful, because such positions put stress on the injury. The pain can be severe enough to wake patients up at night and keep them from sleeping on their shoulders. Patients can also experience different levels of weakness in the injured shoulder, depending on the size of the tear in the rotator cuff tendon. If it is a small tear, the patient may not experience any weakness. If it is a medium tear, the patient may experience weakness when holding something heavy away from his body, or putting his arm over his head. If it is a large tear, the patient will not be able to raise the affected arm, or even use it to eat.
To diagnose a rotator cuff tendon tear, your doctor will need to perform a complete exam of your shoulder. An X-ray will be needed to make sure that the joint is normal, and to look for bone spurs or calcium deposits in the tendon. An MRI may be needed if the diagnosis cannot be made by exam and X ray alone.
There are two basic treatment options for a rotator cuff tendon tear. The first treatment option is physical therapy. This is a good treatment for patients with small rotator cuff tears, or very large rotator cuff tears that cannot be repaired with surgery. It is a good option for patients who want to avoid surgery because of the long recovery afterward, because they have medical problems that make surgery risky, or because the pain from the rotator cuff tear is not disabling. Physical therapy will work for 50% of the patients who chose this option.
The second treatment option for a rotator cuff tendon tear is surgery to repair the tendon. Whether or not a tear is reparable depends on the size of the tear and the condition of the muscles attached to the tendon. Your surgeon will be able to tell you whether your tendon is repairable. The surgery is done arthroscopically. An arthroscope is an instrument with a tiny camera on the end that can be inserted through small incisions around the shoulder and used to visually examine the torn tendon. Your surgeon will place sutures through the end of the torn tendon and tie the tendon down over the bone. After surgery, the tendon takes up to 12 weeks to heal to the bone, and the success of the healing process depends on a few factors:
- The tendon must be thick enough to hold the sutures. If the tendon is thin, like tissue paper, then the sutures will pull through the tendon before it has a chance to heal.
- The patient must limit his movement. If the patient reaches or lifts with the injured shoulder while the tendon is still healing, the tendon can rip through the sutures, preventing it from healing.
- The patient should quit smoking, or use a nicotine patch. Cigarette smoke contains poisonous carbon monoxide, which affects the tendon’s ability to heal.
Studies have shown that under ideal conditions, repairs of medium-sized rotator cuff tendon tears will heal in 70% of patients. After rotator cuff surgery, it usually takes 6 months for the patient to have pain relief, and it takes 12 months for him to recover strength in the injured shoulder. After recovering from surgery, 90% of patients experience pain relief.