Rotator cuff injury: what does it mean?

By Cristiano Antonino On May 30, 2023

The rotator cuff is a set of four muscles that help move the shoulder and keep the joint stable

Being an area subject to frequent stress, the rotator cuff tear is a rather common condition, particularly in patients of advanced age; it can be due both to traumatic events, such as an incorrect movement or a strong impact, and to degenerative processes of chronic or pathological origin.

Depending on the case, the age of the patient and the causes of the lesion, its treatment may include conservative therapy combined with drug therapy, or it may be necessary to intervene surgically with an arthroscopic operation to resolve the problem.

What is the rotator cuff and what is it for?

Shoulder anatomy

The shoulder is a body region of the trunk, located in a lateral-superior position, which allows you to perform a wide variety of gestures.

It is the meeting point of three important bones: the clavicle, the scapula and the humerus.

It is one of the most complex areas of the human body, as it is made up of 5 joints, each of which is supported by different muscle bundles that contribute to its movement.

The five shoulder joints are:

glenohumeral or scapulohumeral joint
Acromioclavicular joint
sternoclavian joint
Scapulothoracic joint
Subdeltoid joint

In all, the shoulder is equipped with 26 muscles, which makes it the most mobile joint of the entire body: this means that on the one hand it allows the execution of more complex movements, but on the other it causes a certain instability of the area, which can cause disturbances in the long run.

Precisely for this reason, the shoulder joints are protected by numerous anatomical structures that stabilize their functionality, among which the rotator cuff plays a fundamental role.

The rotator cuff

The rotator cuff is a muscle-tendon complex thanks to the contraction of which the shoulder remains in its anatomical seat preventing dislocation, i.e. a phenomenon that involves the release of the humeral head from the glenoid cavity; its name is due to the fact that the tendons that make up this apparatus are quite large and form a continuous lamina that wraps around the upper part of the humerus, like a real protective cap.

The muscles that make up the rotator cuff are

Supraspinatus or supraspinatus muscle
Infraspinatus or infraspinatus muscle
Subscapularis muscle
Small round

However, over time, due to the constant load and continuous stress, the complex apparatus of the rotator cuff can undergo disorders and degenerative processes that compromise its functionality.

When we talk about rupture of the rotator cuff we are talking more properly about injuries of a tendon nature: these can be simple local inflammations, or real ruptures that need surgery to be restored.

What are the causes of rotator cuff tears?

As already mentioned, the shoulder is one of the most complex areas of the human body which, thanks to its many muscles and important joints, allows you to perform a large number of activities.

Precisely because of the constant functional load and continuous stress, the shoulders can be subject to numerous problems that can damage their correct functioning: bone fractures, dislocations and rotator cuff injuries are among the most common shoulder ailments.

Specifically, the rotator cuff tear indicates a tear in the tendon tissue with disinsertion of the bone surface.

It can be caused by traumatic events, such as excessive load, a strong blow or a disordered movement, or more commonly it can be due to degenerative processes that determine a thinning of the protective tendon tissue; the chances of suffering a cuff injury therefore grow exponentially with increasing age: in fact, with ageing, even minor traumas or strains can result in a rotator cuff injury.

Types of injury

In most patients who report a cuff tear, the damage concerns the tendons of the supraspinatus muscle: this is mainly due to the fact that it is located in a delicate position between the head of the humerus and the acromion, a bony structure of the scapula, between which it can often be compressed; in addition it presents a critical section, supplied by few blood vessels which causes greater fragility.

The phenomenon of crushing of the supraspinatus tendon is called sub-acromial impingement or impingement.

The infraspinatus, subscapularis, and teres minor muscles are more rarely subject to injury.

When more than two tendons are involved, it is referred to as a massive tear.

The laceration can be partial, in which the tendons are frayed and uneven, or it can involve the entire thickness and lead to complete rupture of the tendon.

Risk factors

The rupture of the rotator cuff is a rather common event among sportsmen: the repetitive use of the tendons, in fact, can lead to excessive thickening which further reduces the subacromial space.

Even some postural defects deriving from a sedentary lifestyle or work activities that impose spoiled positions can subject the rotator cuff to excessive tension.

Finally, in the elderly, the impingement syndrome is quite common due to the weakening of the tendon structures and their partial calcification, associated with the presence of bone spurs called osteophytes.

What are the symptoms?

The main symptom of rotator cuff tear is pain, especially if the injury is traumatic in origin.

The pain is mainly located in the anterior part of the shoulder, but can radiate throughout the arm, especially when movements are made or weights are lifted.

When the lesion is due to a chronic condition, the pain can be intermittent and of variable intensity, accompanied by more or less marked motor difficulties.

The patient may also experience crunches and joint locks when the arm assumes certain positions, especially during night rest.

Although at first the symptoms may seem tolerable, over time, if the condition is not treated adequately, the pain and weakness in the shoulder can come to impair the performance of normal daily activities and work.

Diagnosis

To identify a rotator cuff tear, the patient will need to consult an orthopedist, who will perform a physical examination to evaluate the movements and strength of the shoulder in various directions; these special diagnostic tests aim to measure the joint excursion of the shoulder, the force impressed by the various tendons and the possible presence of pain during the manoeuvres.

If during the visit signs emerge that suggest a lesion of the cuff, the doctor can prescribe further instrumental tests: ultrasound and magnetic resonance can provide useful information about the site of the rupture, the type and extent of the lesion, and are also indispensable for evaluating the most suitable therapeutic approach depending on the case.

Furthermore, in the case of total ruptures, magnetic resonance imaging is essential to evaluate the state of muscle atrophy and the degree of retraction of the ruptured tendon, i.e. how much it has moved away from the point of insertion with the bone.

Care and treatment

The most appropriate treatment for a rotator cuff tear may vary depending on the patient’s age, the type and extent of the injury sustained, or the severity of the symptoms.

In the case of partial lesions, for most patients, it is possible to opt for a conservative therapy which consists of a period of rest, combined with a physiotherapy course for the recovery of motor functions; to counteract the pain and fight inflammation, the doctor can also prescribe a targeted drug therapy.

Even in the case of non-serious full-thickness lesions in elderly patients, this approach can be used.

In most cases, in fact, these are degenerative lesions whose symptoms are chronic in nature: in these cases, the disorder is more acute in an intermittent manner, alternating with periods of more contained pain; thanks to pharmacological therapy and rehabilitation treatments, it is possible to significantly alleviate the symptoms and restore good functionality to the shoulder.

Conversely, if the lesion affects a still young patient, especially if still of working age, or if the lesion does not benefit from conservative therapy, it may be advisable to resort to arthroscopic surgery: it is a micro-invasive procedure which it consists in making small incisions in the anterior and lateral part of the shoulder, in order to reinsert the tendon in its original location through small anchors that are implanted in the bone end.

In order for the operation to be possible, the tendon must still be in good condition and remain sufficiently elastic.

It is generally performed in day surgery and has an average duration of 60-90 minutes.

At the end of the operation, an external orthopedic brace is generally applied to facilitate correct recovery.

In the most serious cases or with a tendency to relapse, it is possible to proceed with the partial or total replacement of the shoulder joint with a prosthesis.

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