Rotator cuff tears are one of the most common sources of shoulder pain and disability affecting adults in the United States. Rotator cuff tears are most often seen in people as they age, and usually occur in individuals over the age of 40.  It is very important to get a proper diagnosis and treatment plan for rotator cuff tears to prevent shoulder pain from getting worse and impairing your function. 

The rotator cuff tendons are a group of four tendons that attach to the upper end of the humerus bone in the shoulder.  The primary job of the rotator cuff tendons is to center the ball (humeral head) in the socket (glenoid) so that the larger deltoid muscle can power your shoulder overhead.

There are two main causes of rotator cuff tears – either an injury or degeneration that happens with age.  An injury to the rotator cuff can happen over time from weakened tissues, or a rotator cuff tear may happen suddenly as the result of an injury such as falling on an outstretched arm. It can also happen over time and with repetitive activities.  Often people will first notice the pain and weakness in the shoulder after a fall or while trying to lift a heavy object.

Rotator cuff tendon tears can vary in severity from inflammation when the tendon is intact and not torn, to partial tears (partially intact tendon), to complete tears also known as full thickness tears.  However, whether you have severe disease or mild disease, the symptoms are usually the same:   

  • The first sign that you may have a rotator cuff tear is that you experience shoulder pain. The pain will often occur at the top of the shoulder and can radiate down the arm to the elbow.  This is a common pain referral pattern for rotator cuff tears.  In fact, oftentimes people will say that do not have shoulder pain, but rather describe it as arm pain.  Persistent pain in the shoulder for greater than 6 weeks should always be evaluated by an orthopedic shoulder specialist.
  • Another common symptom of a rotator cuff tear is difficulty sleeping because of shoulder pain at night, especially when lying flat. While we do not know why people have increased pain at night, we know that it is often very difficult for patients to sleep. 
  • A third sign of a rotator cuff tear is experiencing pain with repetitive work, sports, or even daily activities such as placing a plate in the overhead cabinet.
  • A fourth common symptom of a rotator cuff tear is weakness, especially when trying to lift anything extended away from the body or reach overhead.

It is very important to be evaluated by a doctor if you have shoulder pain and you suspect that you may have a rotator cuff tear.  Treatment for rotator cuff tears can vary based on the severity of the problem.  For some minor tendon irritation or inflammation, physical therapy and a steroid injection can be very helpful and a successful course of treatment.  However, treatment for severe rotator cuff tears (complete tears) is almost always surgical.  It is important to visit with your doctor to get timely treatment, so the problems do not worsen or become irreparable.

Dr. Mitchell Fagelman is a board-certified Orthopedic Surgeon at OrthoTexas.  He is a specialist in diagnosing and treating shoulder pain and injuries.