The rotator cuff is composed of 4 very important muscles. Together they surround your shoulder and help you move the arm. Rotator cuff injuries can cause pain, loss of motion and weakness. Tears of the rotator cuff are very common. That’s because many rotator cuff tears are due to degeneration — like an old pair of blue jeans. The older you are, the more common rotator cuff injuries are. Why is that? What is the cause of rotator cuff tears? In this post we have 5 Orthopedic Surgeons who are considered experts in their field. We will focus on the cause of rotator cuff tears. Our other expert posts cover the treatment of rotator cuff tears.
More than 40% of patients over 60 will have a rotator cuff tear and not even know it
Most people with shoulder pain who are found to have a rotator cuff tear on an MRI do not recall a single, isolated traumatic event. They may have felt a pop when moving their shoulder, but they didn’t fall or get into an accident. When we find a tear in this scenario the cause of the rotator cuff tear is usually “degenerative tendinosis”. Tendinosis is a condition when your rotator cuff tissue simply wore out. Like you favorite pair of blue jeans … or that sock you just poked your toe through. Trauma is another cause of rotator cuff tears, but traumatic tears are far less common then degenerative tears. We are starting to identify techniques to possibly cure tendinosis which could hopefully decrease the risk of having a rotator cuff tear.
Does it matter what the cause of your rotator cuff tear is?
Determining the cause of your rotator cuff tear is very important, because that will influence what treatment is most appropriate for you.
Today we continue with our Expert Series where 4 Orthopedic Surgery experts in the area of shoulder surgery will start off answering a number of questions about the rotator cuff.
Our first post by our experts will focus on the cause of rotator cuff tears, and rotator cuff “disease” or tendinosis.
Scott Slattery, MD: Website, Twitter
The rotator cuff is a group of four muscles and tendons that closely surround the shoulder joint. Rotator cuff tears are very common. Most rotator cuff tears are caused by gradual wear of the tendon material as we age. The area has poor blood supply and is subject to a lot of load and surface wear. Anything that affects the blood supply and tissue quality, like smoking, can make tears more likely. Sudden trauma and strain can speed up this process, and cause sudden complete tears. It’s like wearing a hole in your jeans. Over time the material gradually thins and wears, creating a hole. Sudden strain on the fabric can make it tear more rapidly.
Marty Leland, MD: Website, Twitter, Facebook
What are the leading causes of rotator cuff /disease/tears? As with many musculoskeletal problems, rotator cuff disease can either stem from 1 major injury or as a slow, degenerative process. The acute injuries that can lead to rotator cuff tears include rapid twisting motions of the shoulder (such as in a fight) or shoulder dislocations in patients over age 40. Trying to lift up a heavy object, such as a full briefcase, with the arm completely extended out in front of them, can also cause rotator cuff tears. Other tears are slow and degenerative in their development. These patients do not remember any marked injury to their shoulder, just that it gradually started hurting and became weak.
Jeffery Berg, MD: Website, Twitter
The two leading causes of RC issues are attrition (wear and tear over time) and acute injuries. Attritional issues are more common. These occur as a result of accumulative damage over time (every day use, mild injuries) that is greater than the bodies healing potential. This type of “injury” results in the rotator cuff getting progressively more damaged with time. As a result, these issues are more common in older patients since there is an increased amount of time for damage to accumulate and the healing potential of the tissue is reduced. Acute traumatic tears are less common but usually more symptomatic. These result from an abrupt failure of the tendon, typically at its insertion onto the upper arm, but also occasionally within the tendon substance as well.
Derek Ochiai, MD: Website, Twitter
Rotator cuff issues are very common ailments. The causes (in general) relate to the patient’s age and activity level. In younger patients under the age of 30, the cause can be a violent, traumatic force to the arm/shoulder, tearing the rotator cuff tendons away from the bone. In overhead athletes, such as baseball pitchers or tennis players, the cause may be internal impingement, where the cartilage of the joint rubs abnormally on the rotator cuff. In older individuals, the onset is usually more insidious. While a complete rotator cuff tear may occur, the trauma is usually more mild (such as picking up a heavy suitcase). This is because the tendon is already undergoing degeneration, and typically the patient has some pre-existing (though mild) rotator cuff symptoms.
You can see that a consensus opinion exists. The most common cause of rotator cuff tears is degeneration of your rotator cuff tissue. It’s an unfortunate consequence of genetics, aging and our cumulative activities. Trauma can also cause the rotator cuff to tear. As we will explore in future posts, the cause of your tear will matter when we discuss treatment strategies with you.
Nina Meyer
Dr. Luks…I have 2cm full thickness rotator cuff tear (per 12/14 MRI). “Full thickness tear of the supraspinatus, partially involving avulsion of the osseous insertion, and further posterior, occurring through the critical zone with several millimeter of tendon remaining attached at the insertion. The tear is 2cm in front to back dimension, with retraction to the lateral apex of the humeral head. The infraspinatus is intact, as is the subscapularis. I suffered an injury in early November with an exercise trainer. I scheduled surgery for end of this month – but I am now considering other therapies such as homeopathy and Chinese herbal plaster packs. However, after reviewing your website and watching your video – I am thinking that surgery may be the safest and best option for long term benefits and maximum use of my right arm and shoulder. I am 63 years old. Do you know of any cases where alternative therapies have allowed for healing of a full thickness tear – rather than surgery? Thank you for your perspective, and your website is very helpful. Nina Meyer, Santa Barbara, CA.
Howard J. Luks, MD
Thank you Nina…
Unfortuantely, homeopathic remedies will not heal your rotator cuff. As you read, the treatment of traumatic rotator cuff tears is usually a surgical issue. In cases of a degenerative tear, certain remedies may decrease the pain, but they will not result in tendon healing.
Lei code
Hi doc please refer to above email re full thickness perforation of supraspinatus 15 X 13mm, my orthopod said recommended open surgery for a better repair, I also have calcium deposit in the tedon. I am 57 a rehab nurse and depend on my arm in my job. My doc says mine is due to degeneration and the activity I did (trying to start the lawn mower) probably took its toll. Do you recommend surgery especially an open one? Appreciate a reply, thanks.
Howard J. Luks, MD
I can not provide personal treatment recommendations in this format. As you have read in many posts, treating small degenerative tears with surgery is not always the best option. Also, if you read about calcific tendonitis you will find out that it can frequently be a source of significant pain.
Some surgeons still prefer open surgery to arthroscopy surgery… but that is their preference. There is no proof that it is better. I would consider another opinion, and a long discussion about your options available.
Lei code
Hi Dr. Luks, Thanks for the reply, are you saying that full thickness perforation of supraspinatus even though small does not require surgery, should I seek a second opinion? Thanks so much for your time.
melanie brock
dr luks dr cash recommeneded i see you
i have severe pain in my left shoulder had an mri and it showed torn rotator cuff keeps poppling and swelling and i have some tingling in neck upper back
mri mild acromioclavicular arthropathy modrate glenohumeral joint effusion and subacromual subdeltoid fluid high grade almost complete intrasubstance tear of the anterior to mid and posterior supraspinatus tendon sub labral recess versus slap tear mild subchondral changes of the posterior glenoid
ni my left hand i cannot sleep or use my left side or sleep on it.
what do you suggest i saw one ortho and he said no surgery partial tera sorry for typos i am in tremendous pain no sleep acant lie on it. please respond asap
Howard J. Luks, MD
I suggest you come in and let us examine you.
Howard Luks
jacky south
Dr Luks I am 57 years old I am disable with copd. I would to get your opinion on something if you don’t mind. I am also severely over weight 6ft. 3in and weight 400 pounds. About 3 months ago I got a new cough and had gotten some local boys to help put it in the house but unfortunately these boys couldn’t put a hamburger in a paper bag. I attempted to get in the back of pickup to help and the cough was sticking out in the way and when I lifted myself up on bed of truck I couldn’t lend in as much as I wanted. I was trying to push all 400 pounds up with my right arm. Needless to say it gave way and hurt really bad ( my arm ). I can’t reach out or up without it hurting and it has been getting worst over the last 3 month. I have not been to Dr yet I was hoping it would get better but the real truth is I was scared I would need operation. In your opinion do you think that is where I am headed to. Is there something I can do at home to help. I know you can’t tell me much because you haven’t seen me but any little thing you can tell me to help would be appreciated. Thank you
Howard J. Luks, MD
Hi Jack ..
It certainly sounds like an issue with your rotator cuff. you are correct, an examination is needed to tell you if it is just sore, or if you have a tear.
Good Luck