Running late for work, you reach into the back seat of your car to grab your briefcase.

As you start to lift, you feel a searing pain in your shoulder. You hope it will go away, but the pain continues every time you lift your arm overhead.

Could you have a rotator cuff tear?

Grant Garrigues, MD, a shoulder and elbow surgeon at Duke Orthopaedics, explains the causes and treatments for rotator cuff tears.

Rotator cuff tears are commonly misconceived to be a disease of baseball pitchers. These athletes, however, generally have only rotator cuff scuffing or fraying, with full-thickness tears being extremely uncommon.

Grant Garrigues, MDFor the rest of us, rotator cuff tears are a surprisingly common cause of shoulder pain and limited movement. 

The risk factors for rotator cuff tears are as ubiquitous as age, smoking, and high cholesterol.

While there is debate on the exact cause, most researchers and clinicians believe that rotator cuff tears occur as a result of tendon degeneration and overuse.

In other words, rotator cuff tears afflict a wide range of the population -- from middle-aged weekend warriors to retirees.

The rotator cuff is a series of four tendons that surround the humeral head -- the “ball” of the “ball and socket” shoulder joint.

These muscles work in coordination to hold the humeral head centered on the socket and to allow the shoulder to move. This anatomy allows the shoulder more range of motion than any other joint in the body.

The Duke Sports Medicine and Shoulder Surgery team employs a variety of options to treat rotator cuff tears. Many of these injuries, especially small or partial-thickness tears, can be treated with anti-inflammatory injections and physical therapy -- strengthening the remaining rotator cuff and compensating for the torn portion.

However, rotator cuff tears do not heal. In fact, they tend to get larger with time.

For younger patients with shoulder pain caused by a full-thickness rotator cuff tear, surgery is frequently indicated.

Surgical options include minimally invasive arthroscopic repair or mini-open repair. These techniques repair the torn tendons with minimal trauma and scarring to the overlying deltoid muscle. 

When the tendon tears, it retracts like a spring and gradually becomes scarred in this new position. In these scenarios, it may not be possible to repair the tendon anatomically using standard techniques. For these patients, advanced mobilization and repair techniques, including the use of rotator cuff grafts may be needed.

If the tendon is torn over a long period of time, the muscle may atrophy to the point that it will not move again. In these scenarios, repair is not advisable as it will not improve function.

In this situation, anti-inflammatory injections or minimally invasive surgery can remove the inflammatory tissue and may allow the shoulder to move with less pain.

In some patients with rotator cuff tears so large that they cannot lift their arms from their side, a reverse total shoulder replacement may provide both pain relief and actually allow the patient to lift their arms overhead again. 

Regardless of your age, size of tear, or even if you have had a failed rotator cuff repair in the past, the Duke Sports Medicine and Shoulder Surgery team has a complete toolkit of solutions -- surgical and non-surgical -- to help restore a pain-free and mobile shoulder.

Grant Garrigues, MD, is an orthopaedic surgeon at Duke Orthopaedics, specializing in shoulder and elbow surgery.