The shoulder joint is capable of a greater range of motion than any other joint in the human body. Enabling this range of motion is the rotator cuff, a collection of four muscles and their tendons – consisting of the Superspinatus, Infraspinatus, Teres minor and the Subscapularus. They are responsible for moving the shoulder in internal and external rotation and assisting with overall shoulder stability.
The rotator cuff connects the humerus (upper arm bone) to the scapula (shoulder blade). The tendons attach the muscles to the bones, and the muscles move the bones by pulling on the tendons. The rotator cuff helps raise and rotate the arm.
The shoulder’s great range of motion and capability is put to the test daily, particularly in sports. The most common causes of a rotator cuff tear include repetitive use or a trauma resulting from an accident or strong force. Though stress from repeated activities is more common than traumatic injuries.
Constant strain on the rotator cuff tendons causes the tendons to wear thin and develop a tear over time, sometime referred to as a chronic tear. Traumatic injuries typically occur after accidents such as falling on an outstretched hand and a forceful impact. This type of damage is sometimes referred to as an acute tear. A traumatic injury can cause a rotator cuff tear by injuring the rotator cuff tendons, this type of injury usually occurs in patients younger than 60 years old. As people age the muscle and tendon tissue of the rotator cuff loses some elasticity, therefore rotator cuff tears most often seen in older patients are chronic tears.
The rotator cuff may tear partially or completely rupture. In a partial tear, the shoulder may be painful but the arm is still capable of achieving normal range of motion. A complete tear makes it impossible to move the arm in the normal range of motion and impossible for the patient to raise the arm away from their side. A patient should seek medical care if the pain persists for more than 2-3 days, or if they are unable to work due to pain and unable to move the shoulder and arm. Rotator cuff tears may cause a catching sensation when the arm is moved. Most patients are unable to sleep on the affected side as a result of the pain.
A complete tear is easily detectable in a physical examination. If an orthopedic surgeon is able to move the arm through its normal range of motion but the patient cannot, it is most likely a torn rotator cuff. The doctor will also ask the patient about medical history, the injury and the pain. An x-ray will not show tears in the rotator cuff, but it will show if there are bone spurs, a loss of joint space in the shoulder, or a down-sloping acromion – all of which are associated with tears in the rotator cuff. A magnetic resonance imaging (MRI) scan may also be requested, the scan clearly shows tendons as well as bones.
Dr. Mark Sanders is an orthopedic specialist and sports medicine physician, who has been recognized as one of Houston’s “Top Docs” in H Texas magazine and “Phenomenal Physicians by Health & Fitness. He specializes in shoulder and knee injuries, as well as other common sports injuries. If you are experiencing persistent pain in your shoulder and think you have injured your Rotator Cuff, log onto www.sandersclinic.net to learn more about rotator cuff tears. Or, call 1.888.8 DR MARK (24/7).