What are the causes of a rotator cuff injury? How is a rotator cuff injury diagnosed and treated? Get the facts from experts at Johns Hopkins Medicine.

Understanding Rotator Cuff Injuries

Your rotator cuff is a crucial part of your shoulder, consisting of muscles and tendons that hold your shoulder in place and allow you to lift your arms and reach upward. Unfortunately, rotator cuff injuries are a common cause of pain and disability among adults in the United States.

Symptoms of Rotator Cuff Tears

The most common symptoms of a rotator cuff tear include recurrent pain, especially with certain activities, pain that prevents you from sleeping on your injured side, grating or cracking sounds when moving your arm, limited ability to move your arm, and muscle weakness. It’s important to consult your healthcare provider for an accurate diagnosis, as the symptoms of a rotator cuff tear can resemble those of other conditions.

Diagnosing Rotator Cuff Injuries

In addition to a comprehensive medical history and physical examination, healthcare providers may use diagnostic tests such as X-rays and magnetic resonance imaging (MRI) to evaluate the extent of a rotator cuff injury. Rotator cuff tears can be partial-thickness, where the tendon is not completely severed from the shoulder, or full-thickness, where the tendon is completely torn.

Causes of Rotator Cuff Injuries

There are two main causes of rotator cuff tears: injury and degeneration. A sudden injury, such as a fall on an outstretched hand, can cause a rotator cuff tear. Rotator cuff tears can also develop over time due to repetitive activities or the natural degeneration of the tissues as we age.

Treatment Options for Rotator Cuff Injuries

The treatment for a rotator cuff injury depends on the severity of the injury and the individual’s response to conservative methods. Initial treatment often includes rest, nonsteroidal anti-inflammatory medications, strengthening and stretching exercises, ultrasound therapy, and corticosteroid injections. In some cases, surgery may be necessary for severe injuries that do not improve with conservative treatment.

Innovative Treatment Approaches

In addition to traditional surgical methods, new minimally invasive treatment options are emerging, such as the use of a balloon implant. This procedure aims to improve pain and function for some people with rotator cuff tears who may not be candidates for traditional surgical repair.

Consulting with Experts

If you have a rotator cuff injury, it’s important to work closely with your healthcare provider to determine the best course of treatment for your individual case. The team of orthopaedic shoulder and elbow specialists at Johns Hopkins Medicine is equipped to diagnose and treat a wide range of shoulder and elbow conditions, including rotator cuff tears.

What is the difference between a partial-thickness and a full-thickness rotator cuff tear? A partial-thickness tear does not completely sever the tendon from the shoulder, while a full-thickness tear completely separates the tendon from the shoulder.

How effective are corticosteroid injections in treating rotator cuff injuries? Corticosteroid injections can help reduce inflammation and pain in some cases of rotator cuff injury, but they do not address the underlying tear or degeneration. They are often used as a temporary measure to improve symptoms alongside other treatment methods.

When would surgery be recommended for a rotator cuff injury? Surgery is typically recommended for severe rotator cuff tears that do not improve with conservative treatment, such as physical therapy and anti-inflammatory medications. Factors like the size and location of the tear, as well as the individual’s overall health and activity level, will determine if surgery is the best option.

How does the balloon implant procedure for rotator cuff tears work? The balloon implant procedure is a minimally invasive treatment option that aims to improve pain and function for some people with rotator cuff tears. The balloon is inserted into the shoulder and inflated to support the torn tendon and reduce pain, potentially avoiding the need for traditional surgical repair in some cases.

Rotator Cuff Injury | Johns Hopkins Medicine

What is a rotator cuff injury?

Your rotator cuff consists of muscles and tendons that hold your shoulder in place. It is one of the most important parts of your shoulder.

Your rotator cuff allows you to lift your arms and reach upward. Each year, millions of people in the United States go to their healthcare providers because of a rotator cuff problem. A rotator cuff tear is a common cause of pain and disability among adults.

What are the symptoms of a rotator cuff tear?

The following are the most common symptoms of a rotator cuff tear. However, you may experience symptoms differently. Symptoms may include:

• Recurrent pain, especially with certain activities

• Pain that prevents you from sleeping on your injured side

• Grating or cracking sounds when moving your arm

• Limited ability to move your arm

• Muscle weakness

The symptoms of a rotator cuff tear may resemble other conditions or medical problems. Always talk with your healthcare provider for a diagnosis.

How is a rotator cuff injury diagnosed?

In addition to a complete medical history and physical exam, diagnostic procedures for a rotator cuff injury may include the following:

• X-ray. A diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.

• Magnetic resonance imaging (MRI). A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.

A rotator cuff may tear partially or fully. Partial-thickness tears do not completely sever the tendon from the shoulder.

What causes a rotator cuff injury?

There are 2 main causes of rotator cuff tears: injury and degeneration. An injury to the rotator cuff, such as a tear, may happen suddenly when falling on an outstretched hand. It may also develop over time due to repetitive activities. Rotator cuff tears may also happen due to aging, with degeneration of the tissues.

How is a rotator cuff injury treated?

Treatment may include:

• Rest

• Nonsteroidal anti-inflammatory medicines

• Strengthening and stretching exercises

• Ultrasound therapy

• Corticosteroid injection

• Surgery (for severe injuries)

Johns Hopkins Shoulder and Elbow Surgery

Our team of orthopaedic shoulder and elbow specialists diagnoses and treats common and complex shoulder and elbow conditions, including rotator cuff tears, ulnar collateral ligament (UCL) tears, and shoulder and elbow arthritis. Our specialists are also skilled in different shoulder replacement approaches.

Learn more about shoulder and elbow surgery

When should I call my healthcare provider?

Notify your healthcare provider if:

Key points about rotator cuff injury

• Your rotator cuff allows you to lift your arms and reach upward.

• There are 2 main causes of rotator cuff tears: injury and degeneration.

• The symptoms of a rotator cuff tear may resemble other conditions or medical problems. It is important to talk with your healthcare provider for a diagnosis.

• Your healthcare provider will determine specific treatment for your rotator cuff injury.

Mayo Clinic Q and A: How are rotator cuff tears treated?

• By

  Cynthia Weiss

  June 5, 2022

DEAR MAYO CLINIC: I injured my rotator cuff recently and was told I was not a candidate for surgery. However, a friend shared that there’s a new minimally invasive treatment option that uses a balloon implant. How does this procedure work, and how does it compare to traditional treatments?

ANSWER: The rotator cuff is a group of muscles critical for the strength, stability and function of the shoulder. Tears of the rotator cuff tendons are a common source of shoulder pain, weakness and other problems. Imaging studies, such as radiographs, MRIs or ultrasounds, are used to evaluate rotator cuff tears.

Physical therapy and the occasional use of cortisone injections may improve pain and function for some people with a torn rotator cuff. However, many rotator cuff tears do not improve with therapy, and in those circumstances, surgery needs to be considered.

Repair of the torn rotator cuff tendons is the most performed procedure when surgery is required. Most rotator cuff repairs are performed using arthroscopy. A small camera is inserted into the shoulder through a small incision or cut, and additional small cuts are used for instruments to complete the repair.

Many times, rotator cuff repair is successful. However, certain rotator cuff tears have so much damage that the tear cannot be repaired. These irreparable tears are excessively large and stiff, and oftentimes, the muscles are atrophied and largely replaced by fat tissue, so that even if the repair were to heal, weakness and poor function would remain. Expert evaluation is paramount to select the various options to manage rotator cuff tears.

Irreparable cuff tears can improve with alternative or salvage surgical procedures, which traditionally include superior capsular reconstruction, tendon transfers and shoulder replacement with implantation of a reverse prosthesis. A fourth new procedure just approved in the U.S. involves implantation of a subacromial balloon.

The inflatable subacromial balloon is made of a copolymer that is not toxic, does not elicit inflammation and is biodegradable. This balloon comes folded inside a protective canula. It is deployed at the ball of the shoulder, or humeral head, under arthroscopy. Liquid saline is then injected inside the balloon to inflate it before being sealed. The balloon is resorbed in the human shoulder within a year.

To understand how a temporary subacromial balloon works, it is important to understand what happens to the shoulder in the presence of an irreparable rotator cuff tear. Specifically, the ball of the shoulder moves up and rubs against another bone on top, the acromion.

In these circumstances, several factors may contribute to pain and loss of function:

• The torn rotator cuff muscles cannot power the shoulder.
• The mechanics of the joint are poor with such a high-riding humeral head that is no longer aligned with the socket.
• Rubbing or friction occurs between the humeral head and acromion.
• In some instances, the articular cartilage of the joint can progressively wear with arthritis.

Placement of an inflated balloon in the subacromial space is believed to improve pain and function two ways. First, the balloon does not allow the humeral head to rub with the acromion. Also, with the placement of the balloon, the humeral head is returned down to a more normal position across the glenoid socket, which improves mechanics of the joint.

It is not clear why people experience pain relief and improved function well after the balloon has already resorbed, but the theory is that temporary physical centering of the humeral head across the socket and improvements in pain allow patients to strengthen the rest of the intact muscles around the shoulder so that they can permanently compensate for the torn rotator cuff.

The ideal candidate for implantation of a subacromial balloon is a person with an irreparable, painful rotator cuff tear with minimal or no arthritis and reasonable motion. One North American study showed an 87% success rate two years after implanting a subacromial balloon in patients 65 or older.

Balloon implantation is a minimally invasive and relatively short procedure that does not burn any bridges. However, it neither increases strength nor improves arthritic pain. There is some interest in using the balloon as an add-on to a rotator cuff repair in certain people at risk for incomplete tendon healing, but this use has not been investigated in detail.

If you have been diagnosed with an irreparable rotator cuff tear and have not developed arthritis yet, implantation of a subacromial balloon may be a good option for you. That’s provided your motion is reasonable, and you are not looking for major improvements in strength. It appeals to many as a minimally invasive procedure that, when unsuccessful, does not leave any material behind. As such, it does not negatively affect further surgeries that may be needed in the future. — Dr. Joaquin Sanchez-Sotelo, Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota

****************************

Related Article

• How a new rotator cuff balloon procedure helps some patients get better published 3/18/22

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Rotator cuff tear | Clinical Hospital No. 122 named after L.G. Sokolov of the Federal Medical and Biological Agency

Disease pattern: rupture of the rotator cuff

Damage to the rotator cuff is known as the most common diseases of the shoulder joint. The rotator cuff is made up of four tendons that wrap around the head of the humerus. The main function of these tendons is to transfer the efforts of the corresponding muscles (supraspinatus, infraspinatus, subscapularis, small round) to the head of the shoulder, which provides the shoulder joint with mobility and the ability to withstand the load.

Trauma or chronic damage can cause these tendons to tear. Often, minor traumatic force can lead to serious injury. The most commonly injured tendon is the supraspinatus tendon.

Symptoms.

Patients complain of nighttime pain in the affected joint. Pain can occur both at rest and during exertion. With an increase in the length of the gap, the limitation of the mobility of the shoulder joint increases. In this case, the patient loses the ability to actively raise the affected arm without the help of the second hand. Prolonged presence of tendon rupture leads to a significant deterioration in the function of the shoulder joint.

Diagnosis and preparation for surgery.

The diagnosis of rotator cuff injury is based on the patient’s complaints, physical examination, and additional instrumental findings such as x-rays, ultrasonography (ultrasound) and MRI. In each case, it is necessary to compare both shoulder joints. If the second shoulder joint is also affected, the treatment tactics will be special.

Before the operation, a laboratory examination is required for general anesthesia. It includes an ECG, fluorography, blood and urine tests. These tests can be done on an outpatient basis to reduce the length of your stay in the hospital.

Surgery.

Rotator cuff suture, or fixation of ruptured tendons at their insertion on the head of the humerus, is performed arthroscopically through several small incisions. At the present stage of development of shoulder joint surgery, open interventions have to be resorted to in very rare cases. Fixation of the tendons on the head of the humerus is performed using special fixing anchors, which can be made of titanium or biodegradable materials. Your surgeon will explain to you which type of fixation will be used, as there are a number of parameters that affect the choice. Removal of implants is not provided in any case. The rehabilitation program is selected individually depending on the amount of intervention, which can be adjusted during the operation.

Not every rotator cuff refixation results in full anatomy. In the case of a long-term rupture, the muscles contract, scarring occurs, and the tendons go so far from their place of attachment on the head of the humerus that it becomes impossible to bring them all back to the point of fixation. Under such conditions, it is enough to fix at least one portion of the tendons on the bones. But at the same time, the rehabilitation program will be longer and more careful.

In the event that changes in the joint become irreversible and reconstruction is not possible, subacromial decompression is performed: the bone and soft tissues are processed in such a way as to achieve a significant reduction in pain. Recovery of full shoulder function in this case, unfortunately, is not expected.

Postoperative care.

Each patient receives an individual rehabilitation plan, which describes in detail all postoperative measures. Immediately after the operation, a special orthopedic fixator is applied, which provides protection to the operated joint during the recovery process. For physiotherapy and physiotherapy exercises, the retainer must be removed. The hospital stay after surgery is usually 2-3 days. Outpatient rehabilitation is possible in the conditions of the Central Polyclinic No. 122 (you can agree on the passage of rehabilitation in our conditions by calling +7 (812) 363-11-22).

Perspectives.

The outlook after arthroscopic rotator cuff reconstruction is generally good. Of course, when predicting the results, it is necessary to take into account the totality of factors that determine the general condition of the joint. Dynamic observation and implementation of the prescribed rehabilitation plan are the best recommendations.

Other.

If you have other problems with your musculoskeletal system, please visit our website for information: www.med122.com

Special consultation hours:

Consultations and personal interviews must be agreed by phone: +7(812)559-97-83

Damage to the rotator cuff of the shoulder joint – symptoms, causes, treatment

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Rotator cuff injury is considered as the main cause of chronic pain and joint dysfunction in a patient older than 50 years. Damage of a degenerative nature is more common than post-traumatic tears. Rotational (rotator) cuff of the shoulder – a group of muscles and tendons that surround the joint, holding the head of the bone in a shallow articular cavity, i.e. perform a stabilizing function. Previously, the pathology was called humeroscapular periarthritis. In modern orthopedics with the availability of magnetic resonance imaging and arthroscopy, a shoulder joint injury is diagnosed with a rupture of a specific component / components of the rotator cuff. Treatment, depending on the severity of the pathology, can be conservative or surgical.

CMRT specialist tells

Kuchenkov A.V.

Orthopedist • Traumatologist • Surgeon • Phlebologist • Sports doctor • 24 years of experience

Publication date: June 29, 2021

Verification date: January 15, 2023

All facts have been verified by a doctor.

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Causes of rotator cuff injury

Symptoms of rotator cuff injury

Classification

Diagnostics

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How to treat rotator cuff injuries

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Treatment and rehabilitation after a rupture of the rotator cuff of the shoulder joint in CMRT clinics

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