Rotator cuff tears are one of the most common reasons why people have shoulder pain. But there are many people who have rotator cuff tears and have no pain. Many rotator cuff tears can be treated without surgery and result in a painless, well functioning shoulder. Some of you may have persistent pain despite medications, injections and physical therapy. Therefore, some of you may wish to consider rotator cuff surgery. This post will help address many of the key questions you should have about rotator cuff tears and whether or not you should think about having shoulder surgery. More than ever it is important that you have a good understanding about rotator cuff tears.
The rotator cuff is made up of 4 muscles which control how well your shoulder works. If a tear in the rotator cuff is large enough it can affect how well the shoulder will function. Most rotator cuff tears are actually due to degeneration of your tendons. Some tears may occur because you were injured… such as a fall, or sports injury.
5 Facts You Must Know About Rotator Cuff Tears:
- The most common cause of a rotator cuff tear is degeneration. That means your tissue simply wore out over time. These tears can become larger with time, but that is not always the case. Many degenerative tears are very small. Many patients with degenerative tears can avoid surgery. Take home message: Inquire about your type of tear. If you have a small degenerative tear, a discussion about surgery should only occur after you have failed a proper non-surgical treatment regimen. Recent advances have enabled us to repair rotator cuff degeneration and degenerative rotator cuff tears with a biological patch.
- Trauma or injuries can cause rotator cuff tears. If you have fallen on your side, and now you find that you can not move your arm due to pain and weakness, you have likely suffered a large traumatic tear of the rotator cuff. Traumatic tears are treated differently then degenerative tears. In this case, you had a normal tendon which tore because of a traumatic event. These injuries are typically treated with surgery to repair the rotator cuff. Take home message. If you fell and now have significant weakness… do not wait too long before seeing an Orthopedist. If your tear is large, it will retract and turn to fat. It is better to treat these sooner rather than later.
- Retraction and Atrophy. Muscles in our body are under tension. Like a rubber band stretched between two fingers. If a tendon is torn on one end, it will start to retract or pullback towards the other end. If you have a large tear, then your rotator cuff tear can retract significantly. If it has retracted more than 3 centimeters the repair might be difficult to perform and your result might suffer, or degrade with time. When a muscle is not functioning well, it will turn to fat. Our body is cruel! If you have had a tear for a while, then there is a chance that the muscle has turned to fat.. and is NOT capable of working like a muscle. Unfortunately, once a muscle has turned to fat, it can not turn back into muscle. Take home messages: Talk to your doctor. Is your tear retracted? How far? Ask how that will affect your ultimate result. Do you have fat replacement of the muscle? How much? If it is significant, you may not be happy with the result of an attempted repair.
- Just because something is torn, does not mean it needs to be fixed. I see far too many second opinions where people had an MRI, were diagnosed with a small tear and told that they need surgery. The reason given for the need for surgery was simply because something was torn. That’s simply not true. Many people are living with tears of their rotator cuff and do not even know they have one. Just because something is torn does not mean it needs to be fixed. Take home message. If you have not had trauma or a serious injury and you are diagnosed with a small tear and have not been offered non-surgical treatment options it’s time to see a second opinion.
- Be treated like a person… not an MRI finding. All people are not created equal. All tears are not created equal. When determining what the proper treatment option is for you, your surgeon must take into account the type of tear you have, your story, your goals, your current quality of life and whether or not those goals are achievable given your exam, and your MRI findings. Take home message: Not all tears require surgery. Not all tears can be repaired. What are your goals? They matter! Are they achievable — with or without surgery? Don’t be afraid to ask questions.
Rotator cuff tears : Because you likely have more questions… see these articles for more information.
Click here to read more on the causes of rotator cuff tears.
Click here to read more about the function Rotator Cuff.
Why didn’t my rotator cuff heal?
never thought in a million years i would be writing to an internet doctor! But here goes: I hurt my right shoulder 2.5 years ago after yanking hard on a stuck wetsuit zipper and then swimming a couple of miles. Excruciating pain the next day. PT then my first orthopedic surgeon. He did an MRI which showed nothing alarming, but recommended surgery to “fix everything that was wrong” and hope for the best. Said i would be recovering for a very long time and that it might not solve anything. I declined. More PT cortisone a second opinion. Second guy said nothing wrong with shoulder diagnosed myofascial pain syndrome and sent me to physiatry. More injections, acupuncture, massage etc. no change. Next sports medicine and more pt, then another surgeon who eventually said scapular issues and sent me to well known surgeon to see about scapular surgery. He said no problem with either the shoulder or scapular. Then to a neck and spine guy who said no problem with neck.Then I was sent to yet another shoulder doctor who did do another MRI (my third on the shoulder and one on the scapula) Anyway the latest MRI shows a SLAP tear from 12-7, partial tear of supraspinatus 1.5cm without atrophy and a small tear in infraspinatus and well as other little things. Surgeon says he doesn’t operate of these things at my age-61. Says tendons have frayed and everyone has a Slapper and they don’t hurt. SO what next? I am in constant pain and although I still have a full rom. Cortisone has not helped. I have tried everything. Spent thousands on alternative treatments and to make things worse my left shoulder hurts from the PT. The doctor who sent me to the others for scapula surgery says he can fix the left one, but not until the right one is fixed.HELP! I need at least one arm.
Howard J. Luks, MD says
I’m glad you rolled the dice :- )
So .. partial rotator cuff tears, almost always due to rotator cuff tendinosis CAN be a painful condition. Just because something shows up on an MRI does not mean that it is the cause of pain though. That is my problem and why I can not offer specific advice. Unless I examine someone I do not know what is bothering you. Many shoulder physicians, myself included, utilize Ultrasound guided injections of the various spaces around the shoulder. If we inject a numbing medicine and the pain goes away then we know that that particular area in the likely cause of your pain. In your case, having a radiologist perform an ultrasound guided subacromial injection (the space above the rotator cuff) might be a worthwhile test. If the injection works then you know the source of your pain.
I agree with the “Slapper” doctor… FAR TOO MANY SLAP lesions are being fixed. Most people at 60+ have them and they do not cause symptoms in our age group
So grateful for the excellent information.
I worked as a nursing assistant for 12 years lifting patients, in the past 2 years I felt a soreness & sometimes a little pain in my right shoulder/arm. I thought it was a sore muscle and then it would get better. 2 weeks ago I went bowling & my shoulder , top of my right arm was hurting, that night I was in excruciating pain. Called my doctor & he sent me to have an ultra sound & physical therapy script. The following day I was in awful pain and they got an MRI approved . It should a full thickness tear .
I can not use my arm and I am right handed and the pain is so bad. After everything I read , is it tru that a full thickness tear can not heal on its own? I am a holistic nutritionist and I really do not like the idea of surgery but I can not live like this! I was surprised when I visited an orthopedic surgeon today , that he gave me a cortisone shot. I ask is there anything I can be doing & what’s next surgery? & he said oh no, we would not do surgery before 3 months?
I can’t live like this for 3 months, the shot did not work, I am in pain & have very little use of my right arm. I feel like I’m being made to jump through hoops to go through a process for non-surgical treatment regimen , to satisfy health insurance, when I feel the only option at this point is surgery.
Any thoughts, comments, advice?
Good read thank you :)
In December I was running with my 100 lb dog and best friend. I tripped he kept moving so I landed on my shoulder hyper-extended broke my right shoulder blade and am awaiting surgery in March for a bad tear.
Told not to do anything with it I have not listened because of fear of it getting fat. It hurts worse all of the time. Will I cause it to retract by using it more than I should? What causes retraction?
Howard J. Luks, MD says
retraction occurs over time … even if you try not to use it. It’s an unfortunate consequence of rotator cuff injuries. Not all tears will retract. Usually large tears with two or more muscles will retract.