Rotator cuff
The rotator cuff tear
What a rotator cuff tear is, why the torn tendon can't heal back to the bone on its own, and what causes the pain.
Read the transcript
Introduction
This is Dr Kalman Piper's guide to rotator cuff tears: what a tear is, why it doesn't heal on its own, and what causes the pain.
Supraspinatus
The tendon on top is called supraspinatus. It's the one that lifts the arm, and it's the one that tears most often.
Tear and retraction
When it tears, it usually tears straight off the bone. The muscle at the other end keeps pulling, so the tendon retracts. You end up with a gap between the end of the tendon and the bone. That's a rotator cuff tear. Because of the gap between the end of the tendon and the bone where it attaches, rotator cuff tears can't heal.
The footprint
The patch of bone where the tendon normally attaches is called the footprint. On an MRI scan, a tear shows up as fluid sitting over a bare footprint, with the end of the tendon pulled back.
Measuring the tear
A tear is measured in two directions. Looking from the front shows how far the tendon has pulled back or retracted. Looking from the side shows how wide it is from front to back. These measurements are used to describe a tear as small, medium, large or massive.
Bursitis
Rotator cuff tears are very common. There's often inflammation around them as well, in a layer above the tendon called the bursa. That's bursitis.
Biceps and AC joint
Other structures around the shoulder commonly cause pain too. The long head of biceps tendon runs adjacent to the rotator cuff tendons and a rotator cuff tear often causes inflammation in the biceps tendon causing pain that is felt down the front of the arm. The AC joint sits just above the shoulder joint where the clavicle or collarbone and the scapula or shoulder blade meet. Inflammation in the AC joint is called synovitis and it causes pain on top of the shoulder.
Close
That covers what a rotator cuff tear is, why it can't heal on its own, and why it hurts. The next video explains the treatment options, how Dr Piper repairs the tendon, and what the recovery involves.
More on rotator cuff
Shoulder anatomy
How the shoulder works: the ball and socket, the labrum and capsule, the four rotator cuff tendons, and the bones and deltoid around the joint.
Rotator cuff repair surgery
How a torn rotator cuff is repaired through keyhole surgery, what the anchors and sutures do, and the six months of recovery.