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.
Travis Young
Hi Doc. I’m age 64 ½; a large, (formerly)active male. MRI: 9/24/2015 Full-thickness, Fullwidt tear of suprapinatus tendon, 1 cm medial to the footprint; resulting in 1.8 medial retraction; minimal supraspinatus atrophy labral tear involving posterior & posteroinferior labrum, evidenced by prom. Paralabral cysts (2.0 X 1.0 X 0.6m), and some osteoarthritis. Cause: 8/1/2015 ATV crash. Symptoms: Hurts /aches all the time. Pain subsides when I don’t do anything. I can’t wear suspenders. I favor that arm all the time. Sleep is possible with lots of prep/pillows. My R.O.M. is 96%. I disqualified on 1st [Left]Shoulder arthroscopy surgery date due to really bad cold. 2nd is scheduled 2/8/2016. I’m walking w/light swimming every day.
WHAT ARE MY SURGERY RISKS? I understand I may have degenerative, rotten tendons: I could go through surgery risks, & 8 weeks of considerable pain and 6 more months of recovery with no net gain. Same pain and a repeat-rip. True?
ALSO, AM I CORRECT ABOUT THESE RISKS: 1-Anesthesia complications/reactions- I have controlled-asthma, lungs in good condition and no history of reaction to anesthesia. My heart is strong. 2- staph and strep Infection: Anti-infection steps including pre-washes. Restrict access to surgery. Supply of clean bedding. 3- Nerve Injury: I understand my surgery will not be on (the inferior capsule or labrum) My surgeon is highly thought of. 4. Frozen Shoulder : Because of my injury/age; is this much of a risk? 5-Chondrolysis I understand this is a very rare complication. 6. Head/Neck Injury=no concern See #3.
Thankyou for your Time sincerely t. Young
Howard J. Luks, MD
Good luck Travis…
There are many risks associated with any surgery:
Anesthesia, nerve and vessel injury, infection, stiffness, failure of the repair, loosening of the hardware, failure to alleviate your pain, and on and on. Many/most are low probability risks… but risks just the same.
Lisa
Dr. Luks,
I had surgery for a full thickness tear on my supraspinatus tendon and partial tear on the subscapularis yesterday. I’m a 44yr old female and wanting more info on recovery time. I know physical therapy is in the future for me, but is there any muscle supplements, or nutrition that would help the shoulder muscles? Thanks for any info.
Howard J. Luks, MD
None that we really know of … a healthy diet is all we currently recommend.
Tina
Hi, Dr. Luks, I am a 55 yo female. I am about to have my 4th shoulder surgery since I turned 35. Both shoulders needed impingement release with clavicle resection. The left rotator cuff, labrum, and bicep tendon were repaired two years ago. Now, the right rotator cuff is partially torn. My surgeon will also clear debris and check labrum and bicep again. several years ago, a rheumatologist diagnosed me with “connective tissue disorder and possible lupus.” Since then, two other rheumatologists have disagreed with that diagnosis. Since I have a family history of autoimmune disease, which includes a grandfather who died of complications from lupus, is it possible these shoulder joint issues are related to autoimmune issues? Should I be getting yet another opinion on the CTD or Lupis issue? It just seems that 4 shoulder surgeries in 20 years is a bit much, even for traditional “wear and tear” issues.
Howard J. Luks, MD
Lupus or any other CTD could affect the integrity of your tendon tissue… BUT ! partial tears or fraying is still very common in many people over 50. Partial tears/labral tears are not a reason to consider surgery at our age, unless our pain doesn’t improve with time, injections, PT, oral anti-inflammatories, etc.
Good Luck
Katheryn
Dr Luks
I’ve been told I gave a torn rotator cuff, the problem is I just had surgery 2 years ago for this same problem on the same shoulder. How often does this happen that there’s a repeat of the same problem in the same shoulder.
Howard J. Luks, MD
Most cuff tears occur due to degeneration. Therefore it is not unusual to have a recurrent tear.
The results of revision repairs are not nearly as good as the results of primary or your first repair. Some thing to discus with your surgeon.
Kevin
hi Doc I dislocated my shoulder 4 weeks ago had it in sling for 3 weeks. I can’t lift my arm only few inches I had a mri scan and waiting for result.Do I just need physiotherapy to cute this,or will I need operation, it’s my first ever dislocation and I’m 40 yes old.
Howard J. Luks, MD
Depending on the results of your MRI your doctor will be able to tell you how successful PT will be at restoring your motion and strength.