Rotator cuff tears are a common injury among both athletes and non-athletes who make forceful use of their upper extremities in the course of daily activities. Many rotator cuff tears can improve with conservative treatment, but the key is early diagnosis and appropriate treatment. Recognizing the symptoms of rotator cuff injury is important for anyone who has shoulder pain or who treats patients who present with shoulder-related injuries. This article describes the symptoms of rotator cuff tears.
The Rotator Cuff
The rotator cuff is a collection of tendons and muscles which wraps around and connects the bone of the upper arm into the shoulder joint. Rotator cuff injuries are often divided into two categories: acute and chronic. Acute rotator cuff injuries are usually due to some traumatic or shoulder-stressing event such as catching an object that is falling or falling on an outstretched arm. Chronic rotator cuff tears emerge when an injury to the rotator cuff has gone untreated or when there is daily irritation of the rotator cuff which prevents adequate healing. Orthopaedic physicians also distinguish between full-thickness and partial-thickness rotator cuff injuries, but the initial symptoms are often not different for these types of rotator cuff injuries.
Pain With Injury
Pain is the main feature of a rotator cuff tear, and can be either chronic or acute in nature. Pain is often intensified when the arms are lifted over the head as this activates the muscles and tendons which have been injured most heavily. In some people with rotator cuff tears, the pain can be persistent, even when the arms are still and hanging at the sides of the body. One of the diagnostic tests for rotator cuff tear is injection of a numbing agent into the shoulder joint. If a tear is present which is causing swelling of the tissues to press on other parts of the shoulder joint, the numbing agent will decrease the pain, thereby confirming the diagnosis of rotator cuff injury.
Limited Range of Motion
Limited range of motion is the next most common symptom of a rotator cuff tear. This symptom is usually secondary to the pain that occurs with movement of the arms, but can also result from dysfunction within the muscles and tendons which are torn as a part of the injury. Typically, raising the arms above the head or rotating the arms in such a way as to bend the upper arm bone within the shoulder joint will elicit both pain and muscle tightening which prevents full range of motion.
Weakness of the Arm and Shoulder
Weakness is another symptom of rotator cuff tear, but is more common in the chronic form of the injury. Because of disuse of the arm and muscles in the shoulder in order to prevent pain, the muscles will shrink and become less strong. This results in the shoulder join becoming less stable, which in turn can lead to more pain.
Signs of Injury
Signs of rotator cuff tear are often apparent to both the patient and the health care provider. Guarding is a common sign, where the shoulder is kept still and maybe even held by the other arm because of the pain of moving the arm. Some rotator cuff injuries may also show up on X-rays of the shoulder. Physicians who read these X-rays look for abnormal spaces within the shoulder joint or signs of inflammation or arthritis of the joint. In some cases, physicians may order ultrasound, MRI or other imaging studies in order to evaluate the extent of injury in a suspected case of rotator cuff tear.
References
- "Current Diagnosis & Treatment in Orthopedics;" Harry B. Skinner, M.D.; 2006
- "Orthopaedic Examination, Evaluation, and Intervention;" Mark Dutton, P.T.; 2008
