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How does the rotator cuff get injured?

Your shoulder is made up of three bones: the upper arm bone (humerus), the shoulder blade (scapula), and the collarbone (clavicle). The shoulder is a ball-and-socket joint: The ball, or head, of the upper arm bone fits into a shallow socket in the shoulder blade.

When one or more of the rotator cuff tendons is torn, the tendon becomes partially or completely detached from the humerus.

 
Illustration of a rotator cuff tendon torn away from bone

In most rotator cuff tears, the tendon is torn away from the bone. Most tears occur in the supraspinatus tendon, but other parts of the rotator cuff may also be involved. In many cases, torn tendons begin by fraying. As the damage progresses, the tendon can completely tear, sometimes with lifting a heavy object.

There are different types of tears.

  • Partial tear. This type of tear does not completely detach the tendon from the bone. It is called partial because the tear goes only partially through the thickness of the tendon. The tendon is still attached to the bone, but it is thinned.
  • Full-thickness tear. With this type of tear, there is detachment of part of the tendon from the bone.
    • When only a small part of the tendon is detached from the bone, it is referred to as a full-thickness incomplete tear.
    • When a tendon is completely detached from the bone, it is referred to as a full-thickness complete tear. With a full-thickness complete tear, there is basically a hole in the tendon.
 
Rotator cuff tendons and a full-thickness tear in the supraspinatus tendon

(Left) Overhead view of the four tendons that form the rotator cuff.  
(Right) A full-thickness tear in the supraspinatus tendon.

 
Front view of rotator cuff and full-thickness tear in supraspinatus tendon

(Left) The front view of a normal rotator cuff. (Right) A full-thickness tear in the supraspinatus tendon. 

Courtesy of AAOS 

Do I need imaging?

  • X-rays. The first imaging tests performed are usually X-rays. Because X-rays do not show the soft tissues of your shoulder like the rotator cuff, plain X-rays of a shoulder with rotator cuff pain are usually normal and may show a small bone spur, which is a normal finding. The reason X-rays are done is to make sure you don't have other reasons for your shoulder pain, such as arthritis.
  • Magnetic resonance imaging (MRI) or ultrasound. An MRI can better show soft tissues, like the rotator cuff tendons, than an X-ray. It can show the rotator cuff tear, as well as where the tear is located within the tendon and the size of the tear. An MRI can also give your doctor a better idea of how old or new a tear is because it can show the quality of the rotator cuff muscles.

The goal of any treatment is to reduce pain and restore function. There are several treatment options for a rotator cuff tear, and the best option is different for every person. In determining the best treatment, multiple factors will be considered, including: tear type and severity, age, activity level, and your overall health

Nonsurgical treatment options may include:

  • Activity modification
  • Anti-inflammatory medications or topicals
  • Physical therapy
  • Steroid injection

Surgical treatment

Other signs that surgery may be a good option for you include:

  • Your symptoms have lasted 6 to 12 months
  • You have a large tear and the quality of the surrounding tissue is good (limited or no atrophy)
  • You have significant weakness and loss of function in your shoulder
  • Your tear was caused by a recent, acute injury
 To request a consult with Dr. Logan, please call: 720-726-7995.

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