Is it painful when you stretch your arm over your head?

People who do repetitive arm movements, like tennis players, are prone to rotator cuff tears. — AFP Filepic

My husband was reaching out for something on the top shelf of our kitchen when he felt a sharp pain in his shoulder. He went to the doctor and was told he had a rotator cuff tear. What is a rotator cuff?

Your rotator cuff is situated in your shoulder.

You have two shoulders; each is made out of three bones: the bone of your upper arm (humerus), your shoulder blade (scapula) and your collarbone (clavicle).

You can feel the outlines of these bones if you trace your fingers all around your shoulder.

Your shoulder is a ball-and-socket joint.

The head of your humerus (the ball) fits very nicely into a shallow socket in your shoulder blade.

In order to keep your arm in its shoulder socket, a group of four muscles and their respective tendons come together to hold, shield and protect the head of your humerus.

This group of muscles and tendons are called the rotator cuff.

You are able to lift your arm above your head and rotate it because of this rotator cuff.

Naturally, the tendons and muscles of your rotator cuff don’t rub directly onto your bone during movement – that would be painful and disastrous!

There is a fluid-filled sac called a bursa that provides a cushion between your rotator cuff and the bone on the top of your shoulder joint (called the acromion).

This bursa allows for the smooth movement of your shoulder joint.

Try lifting your arm above your head.

Is the movement easy? Simple? Painless? Without stiffness?

Then your rotator cuff is working normally.

How does a rotator cuff tear then?

Your rotator cuff tears when one or more of the tendons that form it partially or fully detaches from the head of your humerus.

What occurs most commonly in most people is one of the tendons being fully torn away from the humerus.

There are different types of tears, as can be seen below:

• Partial tear

  This type means that your tendon is not completely torn away from your bone, which is why it is called partial.

  Your tendon is still attached to your humerus, but it is thinner than before.

  In many cases, the tear begins this way, with a tendon fraying and thinning slowly, then when there’s a sudden stress on it, it tears completely away from the bone.

• Full-thickness tear

  This type involves full detachment of a part of the tendon from the bone.

  When only a small part of your tendon is detached from the bone, it is called a full-thickness incomplete tear.

  When your tendon is completely detached from your bone, it is called a full-thickness complete tear.

  This basically means there is now a hole in your tendon.

How does a person manage to tear their rotator cuff?

Either through injury, or wear and tear.

An acute tear may be caused if you throw out your arm to protect yourself during a fall and crash onto the ground.

Of course, if the fall is really bad, other bones and tendons can break and tear, such as your wrist for example.

Sometimes, it also happens when you lift something heavy with too much of a jerking motion, e.g. when you are trying to lift a heavy barbell at the gym.

A wear-and-tear tear is also called a degenerative tear.

This type occurs slowly over time as your tendon ages (after age 40).

There is less or no pain involved in this type of tear.

As we age, the blood supply to our rotator cuff becomes less and less.

This makes our tendon unable to heal itself easily.

It happens more often if you use your arm repeatedly to do the same kind of motion, e.g. in rowing, playing tennis and lifting weights.

It also happens more often in your dominant arm.

When rotator cuff tendons tear, the bursa surrounding them can also become inflamed and contribute to the pain.

People who play tennis and use a lot of overhead strokes are particularly vulnerable to rotator cuff tears.

How do I know that the pain in my shoulder is a rotator cuff tear and not something else?

You cannot know for sure unless the orthopaedic surgeon performs an MRI (magnetic resonance imaging) on your shoulder, of course.

But commonly, rotator cuff tears cause pain when you are resting or lying down, especially if you sleep on that particular shoulder for side sleepers.

You may also have pain and/or weakness when you lift, put down or rotate that affected arm, e.g. when reaching for high objects, combing your hair or pulling your T-shirt over your head.

Sometimes, you can even hear a crackling sound in your shoulder.

This is called crepitus, and sounds and feels like the crackling of paper or tissue.

Over time, as you do these motions, the pain and weakness may get worse and worse.

If you tore your rotator cuff because of a fall, the pain is immediate and intense.

Your arm may feel weak immediately after the fall.

Can I avoid surgery?

There are plenty of non-surgical treatments for rotator cuff tears, depending on the severity and your age.

In fact, up to 85% of patients heal with non-surgical treatment, such as rest, physiotherapy and anti-inflammatory drugs.

The doctor can also do a steroid injection into your rotator cuff.

If nothing improves, then you should go for surgery.

Dr YLM graduated as a medical doctor, and has been writing for many years on various subjects such as medicine, health, computers and entertainment. For further information, email [e-mail]. The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. Neither The Star nor the author gives any warranty on accuracy, completeness, functionality, usefulness or other assurances as to such information. The Star and the author disclaim all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.