Tendinitis in the shoulder can lead to an injury called a rotator cuff tear, which causes pain and loss of range of motion in the shoulder. Rotator cuff tears may resolve on their own or may need surgical repair depending on the severity of the tear.
What is a rotator cuff tear?
Your rotator cuff is a collection of muscles and tendons (cord-like bands of tissue that connect muscles to bone) that stabilize the shoulder.
A rotator cuff tear can occur suddenly or gradually from many tiny tears from overuse and aging. Sudden tears can occur when abrupt stress causes one of the tendons to pull away from the bone or tear in the middle. The gradual kind of injury can be caused by chronic wear and tear with the breakdown of the tendon.
Rotator cuff tears can also be partial or complete, meaning the tendon could be torn but still attached to the bone, or it could be completely separated from the bone.
Causes of rotator cuff tears
Rotator cuff tears are a common injury for athletes, especially those who use a throwing movement in their sport or heavy weight-lifting, including pitchers, swimmers and tennis players.
Some occupations and hobbies that repeat the same motions over and over, such as typing, using power tools or painting can cause rotator cuff damage. You can also tear a rotator cuff by falling on your shoulder or using your arm to break a fall.
The incidence of tendon injury increases with age, and it is especially common after age 40. Some medical conditions can increase the risk, including inflammatory arthritis, gout and thyroid disorders. You're also at a higher risk of re-injury if you have already experienced a rotator cuff tear.
Rotator cuff tear symptoms
Your symptoms may depend on your age, health and the severity of your tear.
Symptoms may include:
- Dull, achy pain, usually with overhead activities
- Catching, locking, popping or grinding sound when you use the tendon
- Occasional night pain (after sleeping on the arm) or pain with daily activities
- A sense of instability in the shoulder
- Decreased range of motion
- Loss of strength
Diagnosing a rotator cuff tear
When you seek care for shoulder pain, an orthopaedic specialist will perform a physical exam and ask about your symptoms and medical history. If a rotator cuff tear is suspected, your doctor will order diagnostic testing to confirm the diagnosis.
Because the rim of the shoulder socket is soft tissue, X-rays will not show the damage. Your doctor may order a computed tomography (CT) scan or magnetic resonance imaging (MRI) scan. In both cases, a contrast medium may be injected to help detect tears. Diagnostic ultrasound may also be used.
Rotator cuff tear treatment options
If you're diagnosed with a rotator cuff tear, your orthopaedic physician will discuss the treatment options, both nonsurgical and surgical, available to you. Many patients will not require surgery to repair the tear.
For a partial rotator cuff tear, patients may benefit from nonsurgical treatment options, such as rest, anti-inflammatory medications, cortisone injections and physical therapy. Your physician will ask you to modify your usual daily activity, as your shoulder will require rest to heal. Recovery from a partial tear may take weeks to months to regain strength in the shoulder.
Complete rotator cuff tears, and those caused by sudden, severe trauma may require arthroscopic surgery, a minimally invasive procedure using a camera to repair the tear.