What Are the Causes of Fraying in the Rotator Cuff?

Senior with shoulder pain
Senior man holding his shoulder (Image: KatarzynaBialasiewicz/iStock/Getty Images)

The rotator cuff is a group of tendons in the shoulder that helps stabilize the shoulder. The supraspinatus, infraspinatus, subscapularis and teres minor muscles make up the rotator cuff. According to the American Academy of Orthopaedic Surgeons, the rotator cuff tendons can become weak and prone to becoming frayed or damaged, particularly with age. This can result in shoulder pain, a decrease in shoulder motion and swelling in the shoulder joint. In most cases, conservative treatments are required; however, in some cases, surgery may be necessary. Patients, especially elderly individuals and those involved in high-intensity sports, should understand the causes of rotator cuff tears or fraying.

Injury

Work injuries that involve a lot of overhead lifting, sport injuries that involve excessive upper-arm motion and traumatic injuries such as a car accident can cause fraying or tearing of the rotator cuff. Fraying occurs because of excessive force on the rotator cuff that increases the stress in the tendons and causes tears of the tendon fibers. This type of injury generally results in the acute onset of pain, swelling and limited mobility in the shoulder.

Aging

The AAOS reports that elderly patients are at an increased risk of a rotator cuff tear. This occurs because wear-and-tear use of the shoulder over time can weaken the rotator cuff tendons and make them more likely to fray or tear in the future. The most common rotator cuff tear is that of the supraspinatus. In this case, conservative treatments are usually recommended unless the patient requires the use of the injured shoulder, particularly for overhead movements. If a patient can complete normal functions of daily life, surgery usually is not required. However, a proper treatment plan must be designed by patients and their doctors to fully relieve the symptoms of a rotator cuff fraying or tearing.

Shoulder Impingement

Shoulder impingement is a common cause of rotator cuff fraying, according to the AAOS. Over time, bone spurs can form underneath the shoulder blade and rub on rotator cuff tendons, especially when the arm is elevated. Extensive rubbing of the rotator cuff tendons can weaken the tendons and cause them to be frayed, which will increase the risk of tearing in the future. Rotator cuff tendons have the ability to heal themselves with rest, thus, conservative treatments for shoulder impingement are preferred. If large bone spurs exist in the patient’s shoulder, surgery may be necessary to remove these bone spurs to prevent future impingement. This procedure is called an acromioplasty, and the risks and benefits of this procedure must be discussed between the patient and the doctor.

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