Rotator Cuff Tear

From Economou SG, Economou TS: Instructions for Surgery Patients.
Philadelphia, WB Saunders, 1998, p. 549.

Description
A rotator cuff tear causes pain and weakness of the shoulder due to tearing of the rotator cuff tendons and is often associated with inflammation of the bursa (subacromial bursa). The rotator cuff is a series of four muscles that surround the ball of the shoulder (humeral head). The muscles attach to the shoulder blade on one side and to the humeral head on the other. The muscles attach to bone with tendons. The main function of the rotator cuff is to keep the humeral head in the center of the socket, especially when initiating shoulder motion, such as to reach overhead or perform any activity that requires shoulder strength. The rotator cuff is also important in maintaining shoulder stability and in guiding shoulder motion

Common Signs and Symptoms

Pain around the shoulder, often at the outer portion of the upper arm
Pain that is worse with shoulder function, especially when reaching overhead or lifting
Aching when not using your arm; often, pain awakens you at night, especially when sleeping on the affected side
Occasionally, tenderness, swelling, warmth or redness over the outer aspect of the shoulder
Loss of strength
Limited motion of the shoulder, especially reaching behind (back pocket, bra) or across your body
Crepitation (a crackling sound) when moving the shoulder

Treatment
Initial treatment ice to relieve the pain, stretching and strengthening exercises, and modification of the activity that caused the problem to occur. These all can be carried out at home, although referral to a physical therapist or athletic trainer may be recommended. An injection of cortisone to the area around the tendon (within the bursa) may be recommended. In athletes, surgery is usually recommended to remove the chronically scarred bursa and spur from the acromion and repair the tendon to itself or back to bone. Surgery may be performed arthroscopically or with an open incision. Return to full activity usually requires 6 to 12 months.