Torn rotator cuffs are a frequently encountered problem identified in my office on a daily basis. Sadly, far too many patients are under the assumption that because something is torn, it must, therefore, be fixed. Luckily, many of you with torn rotator cuffs will not require surgery. Let’s dive a little deeper in the shoulder and the subject of rotator cuff tears.
The rotator cuff is four small muscles which control our shoulder stability and motion. These are small muscles which are easily overcome by repetitive stress, age-related degeneration or a traumatic injury. In order to guide you further, let’s answer the following questions.
Torn Rotator Cuffs Questions
- Why are torn rotator cuffs so common?
- What caused my torn rotator cuff?
- Do all torn rotator cuffs require surgery?
The rotator cuff is composed of tendon tissue. A tendon is a structure which connects a muscle to the bone. In the pictures to the right, the rotator cuff is the white tissue you see attaching to the ball which is the top of the arm bone.
Most of our tendons are very thick and very strong. They also have a very firm grasp of the bone they are attached to. Our bodies are very “smart”. The more we use a tendon, the stronger and thicker it gets. Similarly, the less we use it, the weaker it becomes.
Most torn rotator cuffs are not caused by an injury such as a fall. Some torn rotator cuffs are caused by trauma, and I’ll discuss that later. The vast majority of rotator cuff tears involve the tendon of the supraspinatus muscle. Because of how the shoulder works, the supraspinatus is subject to very little stress… therefore the tendon can become thin; its attachment becomes weak, and eventually, a hole develops. Many torn rotator cuffs have a degenerative origin, much like the front of your knee on your favorite pair of blue jeans. This hole is unfortunately called a tear — and many of you believe you have actually torn your rotator cuff. We refer to these common tears as “degenerative rotator cuff tears”. That implies that the tendon simply wore out.
Does all Torn Rotator Cuffs Need Surgery?
There is a lot of recent literature or scientific evidence that many torn rotator cuffs do not become larger and the majority of torn rotator cuffs will not require surgery. Contrary to the studies I just mentioned, there is literature showing that the number of torn cuffs being treated surgically has also risen dramatically. The authors speculate that our fee-for-service reimbursement system is to blame.
The majority of people with a degenerative and torn rotator cuffs can be managed quite effectively with physical therapy, injections, rest from certain overhead activities for a while and patient observation. We do recommend an annual visit to your doctor so they can assess your level of function, pain and perhaps image your rotator cuff with an Ultrasound or MRI to look to see if the tear has become larger. In patients who fail to improve with non-surgical measures, or in patients whose tear becomes much larger, then rotator cuff surgery is indicated.
I mentioned before that most torn rotator cuffs occur due to the fact that our tissues simply wears out. Another (far less common) source of a tear in your rotator cuff is trauma or an injury. Torn rotator cuffs generally require a significant injury to cause a tear. Most shoulder docs would agree. In patients with acute (recent), traumatic tears, surgery is generally indicated to repair the tear and sew it back to the bone it was torn from. PRP or Stem cells for the treatment of torn rotator cuffs is controversial at present… and is the subject of significant investigation.
Jim Champion
I am 67 and lift weights regularly at the gym….I often have popping in the shoulder but little pain ….I am in pretty good shape 5′ 11″ and weigh 188 lbs. Should I be concerned?
Howard J. Luks, MD
The vast majority of popping/snapping in a 60 somethings shoulder is not unusual or abnormal, per se.
ryan
I was performing pushups and after I was done it started to hurt and pop a little, should I be concerned?
Howard J. Luks, MD
Time will tell… many times these issues simmer down, sometimes they persist.
Good Luck
Anthony
I have lifted weights 6 times a week for about 6 six years. Approximately 2.5 years ago I believe I tore my left rotator cuff while at the gym and I was unable to workout and could hardly lift my shoulder for nearly 6 months. After it healed and I started working out again, I noticed my left side was weaker, and when I move it in a circular motion it makes a loud pop as opposed to my right which moves fluidly with no popping sound. I never saw a doctor for the injury, and my question is at this point is there anything that could still be done for it, or is it too late? It doesn’t cause me pain per se, but it certainly does not have the same range of motion as my good shoulder and seeing as I am in my early twenties and would like to be able to workout for many years to come, I want to do anything I can for it. Thank you.
Howard J. Luks, MD
Sounds like you should see a Shoulder Doc to examine you and determine what the next step (if necessary) is.
anthony
Hi I’m 38 years old I had rotator cuff surgery last July 2013. I was doing fine until almost 1 year from surgery I retore it, some how and I don’t know how. Anyway I had an arthogram done and it’s showing 2 tears. The first is in the supraspinatus with 1.3cm retraction and the other is in the infrastr with .07 cm retraction. Iv been to 3 orthopedic specialist who only do sshoulders and they all say I think you should have this done again . What do you think will the second time work
Howard J. Luks, MD
Hi Anthony… The are occasions where a second repair can work. But the results of revision repairs are not as good as those of a primary repair.
Some of us might put a patch or other material on top of a revision repair to try and help it heal better… but we need more evidence to know whether or not that actually improves the overall results.
Good Luck to you.
Howard Luks
Jody
I’ve hurt my shoulder years ago (foolish jump off of a bridge in my 20’s) Now in my mid 40’s I slept slumped over on my elbow on the couch and woke up in brutal pain. It’s been months with little relief and now after I wore a homemade sling for 2 days, it’s unbearable. I can’t turn my hand upward and move it left or right without it clicking and locking up with a ton of very sharp pain. I made everything much worse after tying my arm to my torso and wearing a sling for two days and nights. I can’t use my arm if it’s bent at all. Straight down hanging at my side is fine, bent at the elbow and all movement is crunchy awful pain… any Ideas?
Howard J. Luks, MD
Yes .. please see an Orthopedist