Rotator Cuff Tear
The rotator cuff is comprised of four tendons that attach muscles from the shoulder blade to the humerus (upper arm bone). The subscapularis tendon runs across the front of the shoulder, the supraspinatus tendon runs over the top of the shoulder, and the infraspinatus and teres minor tendons run behind the shoulder. Collectively, these tendons create a sleeve over the shoulder that help lift and rotate the arm in the glenohumeral joint (shoulder socket). A rotator cuff tear is caused by a partial or full tear of any of these four tendons and the most commonly affected tendon is the supraspinatus. Rotator cuff tears result acutely from direct or indirect trauma, abrupt overhead arm movements, or repetitive reaching motions. For example, direct hits to the shoulder in football, abrupt movements like cranking a lawn mower, and repeated movements like pitching a baseball. Tears can also occur chronically from long term tendinopathy (inflammation of the tendon) that leads to a tear. Rotator cuff tears cause anterolateral pain (on the front and to the side) of the shoulder and upper arm and it is intensified while reaching up, out or behind. Pain at night while sleeping is also common. Tears resulting from acute trauma require surgical repair. Nonoperative treatment options include physical therapy, activity modification, oral anti-inflammatory medications (NSAIDs), ice and occasionally steroid injections. If pain continues despite these non-surgical attempts or the tear is a complete tear, surgical repair is frequently recommended to alleviate pain and restore function.