Rotator Cuff Tears of the Shoulder and Arthroscopic Repair

Rotator cuff tears are responsible for many cases of shoulder pain in adults. These tears occur in the set of four muscles that make up the rotator cuff in your shoulder. Since these muscles help you move your shoulder smoothly, a tear in them can make it hard to do normal activities and simple movements, such as raising your arm.

Types of Rotator Cuff Tears

Rotator cuff tears can be partial or full tears. Partial tears occur when you have damage to the soft tissues in this area without any severing. Full-thickness tears occur when the soft tissues are completely torn into separate pieces.
What Causes Rotator Cuff Tears?

Rotator cuff tears can happen due to trauma, such as when you fall and land on your shoulder. When you have a sudden tear occur, this is known as an acute tear. Rotator cuff tears can also develop gradually as the tendons and other soft tissues in this area wear down with age. These tears, known as degenerative tears, are associated with certain risk factors, including doing repetitive motions with your shoulder, having growths called bone spurs and having poor blood supply to the area.

What Are the Signs and Symptoms of Rotator Cuff Tears?

The exact symptoms you experience with a rotator cuff tear depend on different factors, such as whether it is acute or degenerative and how severe it is. Acute tears can cause severe pain and weakness when they occur, while degenerative tears might start out as mild pain and weakness that becomes worse over time or when you try to do certain activities that require lifting your arm.

When you experience pain from a tear, it most often occurs along the side of your shoulder. This pain might only flare up at first when you raise your arm, but it can become a chronic soreness that persists, even when your arm is down at your side. Pain from rotator cuff tears can also become worse when you lie down on the affected shoulder at night. As the pain gets more persistent or severe, you might have trouble performing any daily activities that cause you to lift your arm.

How Are Rotator Cuff Tears Diagnosed?

When you visit your doctor due to shoulder pain, you can expect to undergo a physical exam. Your doctor will have you raise your arm to see how your range of motion is affected. This helps determine how severe your injury might be. Your doctor will also check for tenderness in the affected area. In order to get a more accurate diagnosis of your tear, your doctor might do diagnostic imaging tests, such as X rays or magnetic resonance imaging (MRI). Since X rays do not provide an in-depth look at the tendons and other soft tissues in your shoulder, your doctor might need to do an MRI. This type of test helps your doctor make a better assessment of your condition.

How Are Rotator Cuff Tears Treated?
In many cases, rotator cuff tears can be treated with nonsurgical methods, such as resting, limiting physical activities and taking over-the-counter pain relievers or anti-inflammatory medications. Your doctor might also recommend doing physical therapy exercises to improve your range of motion and strengthen your shoulder muscles. For severe or persistent pain, your doctor might prescribe steroid injections, such as cortisone.

If these measures do not improve your condition or if it becomes worse, your doctor might recommend surgery. Surgical procedures for rotator cuff tears include arthroscopic repair and open repair. Arthroscopic repair is typically preferred since it involves making small incisions, which lowers the risk of tissue or nerve damage, excessive bleeding and other complications. This type of surgery involves placing a very small camera and tiny instruments inside incisions. The camera allows your surgeon to get a better look at the affected area and repair damage. Arthroscopic repair generally has a shorter recovery time due to the tiny size of the incisions. This type of surgery also does not require cutting into the larger muscles in the area, leading to less pain and discomfort afterwards.

With open repair, your surgeon makes a larger incision and cuts into the large shoulder muscle called the deltoid. This type of surgery is usually done for large tears or if you have a complex tear. Open repair surgery has a longer recovery time and a higher risk of infection, bleeding and other complications.