Why does a torn rotator cuff happen, and how are they treated?

The movement of the arm and the shoulder is controlled by a group of four muscles called the rotator cuff. This group of muscles is attached to the shoulder blade and then inserted to the upper part of the humerus. They control the way in which the arm is internally and externally rotated and how it is lifted up and down. At the end of each muscle is a tendon that attaches to the bone. Tears in these tendons are called rotator cuff tears, and they are a common cause of shoulder pain and weakness.

The rotator cuff is frequently injured in several common ways:

• Frequent use of the hands in the overhead position can weaken the rotator cuff and eventually lead to tears in the tendons. Certain athletes, like baseball pitchers, and overhead workers like painters and sheet-rock workers frequently develop tendinitis. This causes inflammation, pain, and tenderness in the cuff. Over time, the wear and tear on the rotator cuff can lead to a tear in one of the tendons.

• A direct blow to the shoulder, a fall onto an outstretched hand, or a dislocated shoulder joint can also result in a tear of one of the rotator cuff tendons. This type of tear would be called a "traumatic tear."

• As we age, so does the rotator cuff. A process of natural wear and tear breaks down the strength and flexibility of the rotator cuff tendons, which can lead to a complete rupture of one of the tendons. This type of a tear would be called a "degenerative tear."

A torn rotator cuff can be treated very successfully by a combination of physical therapy, exercises and shoulder surgery (if necessary). Each of these options has a very important role in the treatment of a torn rotator cuff, but before we discuss them, we will first discuss the shoulder anatomy of the rotator cuff, and why some tendons are more easily injured than others are.

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