A rotator cuff tear is a common cause of shoulder pain and disability among adults. Each year, almost 2 million people in the United States visit their doctors because of rotator cuff tears.
A torn rotator cuff may weaken your shoulder. This means that many daily activities, like combing your hair or getting dressed, may become painful and difficult to do.
The shoulder is a ball-and-socket joint made up of three bones:
The ball, or head, of the upper arm bone fits into a shallow socket in the shoulder blade.
This illustration of the shoulder highlights the major components of the joint.
Your arm is kept in your shoulder socket by the rotator cuff. The rotator cuff is a group of four muscles that come together as tendons to form a covering around the head of the humerus. The rotator cuff attaches the humerus to the shoulder blade and helps to lift and rotate your arm.
The rotator cuff tendons cover the head of the humerus (upper arm bone), helping you to raise and rotate your arm.
There is a lubricating sac called a bursa between the rotator cuff and the bone on top of the shoulder (acromion). The bursa allows the rotator cuff tendons to glide freely when you move your arm. When the rotator cuff tendons are injured or damaged, this bursa can also become inflamed and painful.
When one or more of the rotator cuff tendons is torn, the tendon becomes partially or completely detached from the head of the humerus.
In most rotator cuff tears, the tendon is torn away from the bone.
Most tears occur in the supraspinatus tendon, but other parts of the rotator cuff may also be involved.
In many cases, torn tendons begin by fraying. As the damage progresses, the tendon can completely tear, sometimes with lifting a heavy object.
There are different types of tears.
(Left) Overhead view of the four tendons that form the rotator cuff.
(Right) A full-thickness tear in the supraspinatus tendon.
(Left) The front view of a normal rotator cuff. (Right) A full-thickness tear in the supraspinatus tendon.
Tears to the specialized cartilage tissue in the shoulder known as the labrum can cause pain and instability in the shoulder.
The labrum is a cup-shaped rim of cartilage that lines and reinforces the ball-and-socket joint of the shoulder. The shoulder joint is composed of the glenoid (the shallow shoulder "socket") and the head of the upper arm bone known as the humerus (the "ball"). The labrum is the attachment site for the shoulder ligaments and supports the ball-and-socket joint as well as the rotator cuff tendons and muscles. It contributes to shoulder stability and, when torn, can lead to partial or complete shoulder dislocation.
Illustration of the shoulder joint with the labrum shown in blue.
The most common symptoms of a shoulder labrum tear are shoulder pain, instability and, in some cases, a feeling of grinding, locking or catching while moving the shoulder. These symptoms may vary depending on the type of labral tear a person has.
Among baseball players, pain is frequently felt when throwing, particularly between cocking and releasing the ball, and it may expand to the front of the shoulder during these movements. This soreness is frequently associated with biceps-related difficulties, such as releasing the ball and following through.
Illustration of the shoulder joint with a labral tear.
Patients often note that pain increases during activities that place strain on the shoulder, such as carrying large objects, pushing, throwing, or doing overhead tasks such as serving in tennis. Depending on the severity, they may have additional symptoms such as clicking, locking, snapping, grinding, or a sense that their shoulder is unstable.
The two most common types of labral injuries are thend Bankart tear. Both types of tears are usually accompanied by aching pain and difficulty performing normal shoulder movements.
SLAP stands for "superior labrum from anterior to posterior." This type of tear occurs at the front of the upper arm where the biceps tendon connects to the shoulder. Athletes most prone to this injury include baseball pitchers, volleyball, and lacrosse players who engage in high-energy, quick-snap motions over the top of the shoulder which test the structures in the shoulder. This is why the term “overhead athletes” is often used when describing labral pathology. Patients with SLAP tears may experience pain at the front of the shoulder near the biceps tendon.
Bankart tears typically occur in younger patients who have dislocated their shoulder. When the shoulder joint ball slips out of the socket, the joint capsule (fibrous tissues that surround and protect the joint) can pull on the lower portion of the labrum and tear it. This in turn creates instability because the breached labrum makes it easier for the shoulder to dislocate again. A dislocation where the head of the humerus shifts toward the front of the body, it leads to what is called "anterior instability." When the ball slips toward the back of the body, it leads to "posterior instability." Anterior instability is more common than posterior instability.
With Bankart tears, patients may feel apprehension that the shoulder may slip out of place or dislocate in certain positions.
Unfortunately, labral tears are hard to prevent, especially in athletes, because the force of the overhead motion contributes to the injury. Although athletes are most prone to labral tears, people who experience a traumatic event – such as falling down a flight of stairs – are also at risk. This is especially the case in older adults, because our cartilage becomes more brittle with age.
In some cases, the labrum can heal with rest and physical therapy, depending on the severity of the tear. Surgeons should try to be as conservative as possible when treating a torn shoulder labrum. Surgeons will start with a physical exam of the shoulder and aollowed by annecessary to determine the severity of the injury and the appropriate treatment.
