In this article from The Johns Hopkins Arthritis Bulletin, Drs. Steven A. Peterson and Edward G. McFarland answer questions about rotator cuff pain.
Of all the joints of the body, your shoulder is capable of the widest range of motion. This amazing flexibility allows you do just about anything, from picking up a suitcase, brushing your teeth, and throwing a 90-mph fastball, to scratching your back, and hugging your spouse. All of this can dramatically change, however, when shoulder pain develops, and freedom of movement is affected. An estimated 20% of Americans will suffer from shoulder pain during their lifetime, with many having their damaged shoulder joint replaced surgically to relieve the pain and restore motion. Others will require rotator cuff surgery.
Q. Can the rotator cuff be torn?
A. Rotator cuff tendons have a very low blood supply, which leaves them vulnerable to degeneration as one ages. Rotator cuff damage increases naturally with age, typically in the dominant arm. Repeating the same type of shoulder actions can accelerate shoulder degeneration, whether it be swimming laps, washing windows, or carrying a heavy briefcase.
The interesting thing about rotator cuff tears is that while rotator cuff tears are a common shoulder pain source, as many as 5-40% of people without shoulder pain have a torn rotator cuff and never know it. Ignoring existing chronic shoulder inflammation or sustaining a sharp blow or fall on an outstretched arm may cause the rotator cuff to tear partially or completely.
An initial symptom is sharp pain in the shoulder that may radiate down to the elbow. Even so, the arm can still be moved in a normal range of motion. However, when the rotator cuff completely tears, the arm often cannot move in its normal range, and sometimes the arm cannot be raised from the side without assistance.
Q. What are the options for someone with a torn rotator cuff?
A. Many people think that because their rotator cuff is torn, they need to have surgery to restore use of their arm and get back shoulder flexibility. However, all partial tears of the rotator cuff do not require surgery. Even with a tear, some people will find that they still have reasonably good function and relatively little shoulder pain.
Good candidates for nonsurgical therapy for partial tears of the rotator cuff include those who:
- Are bothered by pain
- Are not concerned with regaining lost shoulder strength
- Will modify all activities that cause shoulder pain symptoms. When there is a complete tear of the rotator cuff tendon, the goal of rotator cuff surgery is to get the tendon to heal to the bone so that shoulder pain is reduced and strength and range of motion of the shoulder are increased
Good candidates for surgical therapy for a torn rotator cuff include those who have:
- Much shoulder pain or loss of function
- Failed nonsurgical management
- Tears that cause profound shoulder weakness
- Tears caused by acute trauma
