Generally, the most painful motion with a partial rotator cuff tear is lifting things over the shoulder level or far away from the body.
Lifting in this manner is very stressful on the shoulder. Many activities may not hurt at all, including running, cycling, swimming, lifting weights, etc. If you do have pain, you can try cutting back on that exercise or activity, but there is no evidence that continuing the activity will worsen the tear. MRI scans are most commonly used to diagnose partial rotator cuff tears.
The most common condition that mimics a rotator cuff tear is shoulder stiffness or a frozen shoulder. This condition is characterized by reduced range of motion — the shoulder will only move so far before starting to hurt. It is common for a patient to develop a stiff and painful shoulder with no injury. A radiologist may read the resulting MRI scan as showing tendinosis or a partial tear of the rotator cuff.
These findings, although they may be true, may have nothing to do with the source of the pain. Partial tears of the rotator cuff seen on MRI scans have meaning only if the symptoms and examination are consistent with that diagnosis. As tendinosis increases, eventually it can be seen with the naked eye. When a tendon begins to tear, it looks like fibers of a rope that are splitting and fraying.
One study that examined MRI scans from people over age 60 found that more than 50 percent had partial tears of their rotator cuff tendons and never knew it. A finding of a partial tear of the rotator cuff is essentially normal in people over the age of Download a Woman's Guide to Sports Injury Prevention and Treatment While active men and women may be equally likely to get hurt, some sports injuries affect women more often or in different ways. This guide explains the biggest risks active women face and how you can run, play or work out smarter to prevent injury.
Get your free copy. If there is no pain, then no treatment is necessary for a partial tear of the rotator cuff tendons.
Lifting in this manner is very stressful on the shoulder. This restores a natural range of motion. Generally, partial tears of the rotator cuff are treated without surgery. This means your labrum is torn at the top in both the front anterior and back posterior of where it attaches to the biceps tendon. First, is the tear really causing your pain? When you slip, it's normal to stretch out your arm to break the fall. Surgeons often repair labrum SLAP tears with arthroscopy, in which the doctor makes and works through small cuts in your shoulder.
If the shoulder is painful, then you have several treatment options. Generally, partial tears of the rotator cuff are treated without surgery. The treatment is focused on maintaining the range of motion and preventing the shoulder from becoming stiff. Administering cortisone shots into the bursa near the rotator cuff tendons to reduce inflammation. The decision to have surgery is based on how much your symptoms affect your quality of life.
Surgeons may see a large shoulder tear on an MRI scan , but if the injury is not causing significant pain or dysfunction, surgery is probably not necessary. Alternatively, a tear that causes chronic pain or weakness in the arm may warrant surgery.
For most people who need surgery for a tear in the rotator cuff, a biceps tendon, or the labrum , NYU Langone doctors recommend arthroscopic surgery. This minimally invasive procedure allows the surgeon to access the shoulder using very small incisions, reducing damage to surrounding muscle and ligaments, and making recovery faster and easier.
A surgeon performs arthroscopic surgery using a slim instrument called an arthroscope, which has a video camera and a light at one end. When the surgeon inserts the arthroscope into the shoulder through a small incision, it sends a video feed to a nearby monitor.
This gives the surgeon a clear view of the interior of the joint and shows tiny details in the tendons and labrum. Next, the surgeon inserts small surgical tools into the shoulder through a separate small incision.
With the video feed provided by the arthroscope as a guide, he or she uses these tools to correctly position a torn tendon or labrum and reattach it to the bone. During arthroscopy, the doctor may find rough protrusions called bone spurs on the acromion, a bony projection at the top of the shoulder blade that forms part of the shoulder joint. If so, he or she may use a small tool to shave them down.
Bone spurs may interfere with the smooth, gliding motion of the joint and cause tendons to tear. General anesthesia is typically required for people having arthroscopic surgery for a shoulder tear.
Doctors also often use a nerve block, an injection that temporarily prevents nerve signals from reaching the shoulder. This provides 10 to 12 hours of pain relief after surgery.
At NYU Langone, arthroscopic surgery is an outpatient procedure, so you can expect to return home within hours of surgery. Doctors may prescribe pain medication for the first week or two so you can heal comfortably.
One such study found that 28 percent of people over the age of 60 had a full tear and didn't even know it. Between the ages of 40 and 60 this number dropped to 4 percent. Another similar study found more than 50 percent of patients over the age of 70 had either a partial or a full tear without any symptoms. How many of these patients may or may not develop pain over time is unknown. The moral of this story is that a trial of physical therapy and injections is often the best first intervention for patients over the age of In these cases, the pain may be just acute inflammation occurring in the setting of a chronic tear; i.
This is especially true in cases of atraumatic shoulder pain, which is usually the rule as opposed to the exception. A well designed multicenter trial comparing the results of operative versus nonoperative rotator cuff tear treatment is under way. At this time the results are still unpublished, but early data has shown very favorable results with physical therapy alone for atraumatic tears in patients over A second factor in whether or not to have surgery is my patient's individual goals.
A young patient who works overhead in construction is very different from a retired patient who only has to reach overhead to shower or reach into a cupboard. I am more likely to recommend an operation to the former patient than the later if therapy fails. Further, for patients that are simply scared to have surgery, have many other diseases that make surgery risky, or who cannot take the time to go through a postoperative recovery process, I would defer an operation. A rotator cuff tear is quite unlike appendicitis: A third factor in my operative decision making is the tear itself.
Some large and retracted tears may not be possible to repair. Occasionally, in a shoulder that has not been used for a very long period of time, the muscle may be replaced by fat. In these very unusual cases, even if the tear is amenable to repair, the muscle can no longer work to move the shoulder: Also, if arthritis is present in the setting of a rotator cuff tear, a rotator cuff repair is unreliable in relieving pain, because the arthritis is still present.