Ask Dr. Skendzel About Torn Rotator Cuff Symptoms

Shoulder injuries are more common than you might suspect. Every year, about 2 million people in the United States consult their doctor about symptoms signaling a torn rotator cuff. In addition, a lifetime of reaching, lifting, and throwing slowly takes a toll on our shoulder joints. By the time we reach 66 years of age, half of us will have rotator injuries—even if we don’t experience any symptoms. Summit surgeon Dr. Jack Skendzel discusses the anatomy of the shoulder joint and describes symptoms that signal a rotator cuff injury.

How the rotator cuff works

“Before we talk about injuries, I think it’s helpful to understand shoulder anatomy,” he says. “Our rotator cuff is a group of tendons attached to the top of the shoulder bone, or humerus. These tendons anchor muscle to bone, help to stabilize the shoulder, and enable our arm to perform. When we reach out, reach behind, lift, and rotate our arms, that’s the rotator cuff in action.”

How torn rotator cuff injuries occur

“Minnesotans work hard, love their cabins, and embrace an active lifestyle right through our snowy, slippery winters,” grins Dr. Skendzel. “All this healthy activity is great. However, as we age, our joints can lose resilience and make us more prone to injury. And we are all vulnerable to slip and fall injuries, regardless of age. At Summit, I see a lot of patients in the 40- and 50-year-old age range who sustain a rotator cuff tear while putting in or taking out a dock, cutting wood, or getting their cabin ready for the summer season. During the winter, there is also a spike in slip and fall accidents. As a result, about 30 percent of my practice is about treating rotator cuff tear injuries.”

Three dynamics underlie torn rotator cuff injury

Dr. Skendzel explains that rotator cuff tear injuries fall into three categories.

• Genetic predisposition. “Some patients have family history of tears,” he explains. “Or an inherited bone structure or physical condition predisposes them to this injury.”
• “Other patients injure the shoulder during sudden trauma,” notes Dr. Skendzel. “The causes of these acute tears include falls and car accidents. Sometimes, reaching out while holding something heavy may also cause shoulder tendons to tear.”
• Joint degeneration. “These injuries occur slowly over time,” says Dr. Skendzel. “Underlying causes of degeneration include the repetitive stress of a physical job. Painters, electricians, and pipefitters are particularly at risk. Repetitive degeneration may be an issue for some athletes, too. Lack of blood supply in the shoulder joint can also cause tissues to degenerate over time; this problem becomes more of a risk as we age. Finally, bone spurs can contribute to degeneration when they cause a mechanical impingement. Extra bone repeatedly pinching the joint tissues or repeated wear and tear causes tendons to fray and slowly tear away from the top of the humerus bone. Once degenerative tearing is set in motion, a tear will continue to get larger over time unless it is treated.”

Two types of torn rotator cuff injuries

“In general, we think of tears as either a full-thickness tear or a partial tear,” Dr. Skendzel explains. “My approach to treatment is determined by the type of tear you have.”

• Partial tears. “A partial tear is a condition where some of the tendon fibers are torn, threadbare, and weakened, but some are still attached to bone,” says Dr. Skendzel. “In general, partial-thickness tears are treated more conservatively with cortisone injections and physical therapy rehabilitation.”
• Full-thickness tears. “This is a complete tear,” he explains. “The whole tendon has torn off the bone. Often, when patients have a traumatic rotator cuff tear, we want to fix it surgically sooner rather than later. While the tear is fresh, the tendon can easily be mobilized back into proper position. It hasn’t had a chance to retract, atrophy, or weaken. If we delay surgery for complete tears, outcomes become more unpredictable.”

Risk factors for a torn rotator cuff

“Understanding risk factors is important, even if some of those factors are tough to prevent,” notes Dr. Skendzel. “When you are better informed, you can recognize and address a potential injury.”

• “Age is the biggest risk factor,” states Dr. Skendzel. “We know that if we examine a group of older individuals, we’ll find that at least half of them have rotator cuff tears whether or not they have symptoms. But remember, having a tear in your rotator cuff does not necessarily mean you need to treat it. Experiencing symptoms is what triggers treatment; that’s why it’s important to do a good history and medical examination.”
• “Everyone knows that smoking is bad for us, and research has confirmed that it’s bad for rotator cuffs, too,” says Dr. Skendzel. “Smoking has a negative effect on musculoskeletal health. If you have a torn rotator cuff, smoking can increase the size of the tear. It will also have an adverse effect on your outcome following surgery to fix the tear.”
• Repetitive motions. Certain kinds of physical jobs and sports increase the risk of shoulder injury. “I treat rotator injuries in professional pipefitters, plumbers, electricians, and construction workers,” says Dr. Skendzel. “Athletes including baseball players and swimmers may also be at higher risk.”

Symptoms

“The symptoms of a torn rotator cuff are pretty straightforward,” says Dr. Skendzel. “If you’ve suffered a traumatic shoulder injury, or if you are older and noticing that daily activities are a struggle, be alert to the following symptoms”:

• You may experience pain performing daily activities or when engaged in specific athletic activities such as throwing, push-ups, or pull-ups.
• Difficulty sleeping. A torn rotator cuff may make it difficult to get a good night’s sleep, especially if you try to sleep on the injured shoulder.
• Shoulder weakness. A rotator cuff injury may make it difficult to extend or lift your arm and may limit your arm’s range of motion.
• Popping and clicking sensations. You may hear mechanical popping and clicking noises in your shoulder. Or you may experience a catching sensation as you move your arm.

When is it time to consult a shoulder specialist?

“If you have persistent pain that’s not getting better with rest and anti-inflammatories, schedule a medical examination,” says Dr. Skendzel. “If you have weakness in your arm when you reach out or overhead, or if you can’t lift your arm, you should definitely come in. Finally, if you fall on the ice during the winter or while waterskiing in the summer, or have a sudden shoulder injury that remains painful for more than two weeks, it’s time to call for an appointment.”

Summit Orthopedics offers comprehensive sports medicine expertise

From Olympians to pro athletes to kids in youth sports and those who just want to be more active—Summit Orthopedics delivers expert care by fellowship-trained sports medicine physicians. If you are recently injured or concerned about ongoing pain, Summit Orthopedics sports medicine specialists have the expertise to evaluate your discomfort and develop a plan to quickly and safely help you get back to being active.

Start your journey to stronger, healthier athletic condition. Find your sports medicine expert, request an appointment online, or call us at (651) 968–5201 to schedule a sports medicine consultation.

Summit has convenient locations across the Minneapolis-St. Paul metro area, serving Minnesota and western Wisconsin. We have state-of-the-art centers for comprehensive orthopedic care in Eagan, MN, Plymouth, MN, Vadnais Heights, MN, and Woodbury, MN, as well as additional community clinics throughout the metro and southern Minnesota. 

More resources for you

• Meet Summit Orthopedics surgeon Dr.  Jack Skendzel
• Ask Dr. Skendzel: Can I recover from injuries as quickly as a football star?
• Check out Skendzel’s feature article in MD News-Minnesota
• Dr. Skendzel Explains Rotator Cuff Surgery
• What’s New in Minimally Invasive Shoulder Surgery?

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