Rotator Cuff Tear

Introduction (What Is Anatomical Location)

Shoulder pain is one of the most common musculoskeletal complaints. It can occur in any age group for various reasons. Most frequently the shoulder pain results from trauma and overuse of the shoulder joint and surrounding tissues, some traumas can cause the rotator cuff tear and further shoulder tendinitis or other conditions, which need to be treated.

The rotator cuff is a group of flat tendons, which fuse together and surround the front, back, and top of the shoulder joint like a cuff on a shirtsleeve. These tendons are connected individually to short, but very important, muscles that originate from the scapula. When the muscles contract, they pull on the rotator cuff tendon, causing the shoulder to rotate upward, inward, or outward, hence the name “rotator cuff.”

A rotator cuff tear is a tear of one or more of the tendons of the four rotator cuff muscles, this condition can further lead to the various types of shoulder tendinitis. The term “tendinitis” came into common parlance to describe chronic painful tendon injuries that involve large-scale acute injuries accompanied by inflammation.

If the inflammation of the tendons is in the shoulder joint it calls a rotator cuff tendinitis.

Rotator cuff tendinitis occurs when the tendons (the cord of tough tissue that connects muscles to the bones) are injured, usually as a result of repetitive overhead reaching, pushing, or lifting with outstretched arms.

What is anatomical location?

Epidemiology (Prevalence, Incidence)

Rotator cuff tear is a common cause of pain and disability among adults. More than two million people in the United States went to their doctors because of a rotator cuff problem in 2008. Tendons in the rotator cuff can become inflamed due to overuse or overload, especially when people performs a lot of overhead activities, such as in tennis, swimming or racquetball, therefore a shoulder tendinitis is very common in sports.
Epidemiology (prevalence, incidence)

Rotator Cuff Pain Symptoms

Rotator cuff symptoms may include: pain and tenderness in the shoulder, especially when reaching overhead, reaching behind your back, lifting, pulling or sleeping on the affected side, shoulder weakness, loss of shoulder range of motion, inclination to keep your shoulder inactive

Causes, Contributing and Risc Factors

Rotator cuff tears are very common. Trauma, such as falls, lifting, and pulling forcefully can also cause a rotator cuff tear. When this happens, it is called an acute tear. Although the rotator cuff can be damaged from a single traumatic injury, damage to the rotator cuff usually occurs gradually. Age can be a factor. As we age, the tendons of the rotator cuff become weaker and more likely to be injured. The blood supply to the tendons diminishes with age. Rotator cuff tears are much more likely to occur after the age of 40.Certain activities can increase the wear and tear on the rotator cuff. Repetitive overhead activity such as painting, plastering, racquetball, weightlifting, and swimming can cause wear and tear of the rotator cuff. In older patients, this can result from comparatively mild trauma or just age related to chronic tendonitis.

Rotator Cuff Tear Diagnosis

A rotator cuff tear is best diagnosed with a scan. The type of scan depends on the local resources and skills.

Ultrasound Scan – in some cases this can be done immediately in the clinic and is accurate, dynamic and cost effective.

Rotator cuff tear diagnosis

MRI Scan – This is more costly and less accessible, but can provide information on the quality of the muscles and other underlying structures of the shoulder.

Rotator Cuff Pain Treatment

The goal of any treatment is to reduce pain and restore function. There are several treatment options for a rotator cuff tear, and the best option is different for every person. In planning your treatment, your doctor will consider your age, activity level, general health, and the type of tear you have.

The most common treatment methods include:

  • Painkillers and anti-inflammatory medications
  • Physiotherapy – keeps your shoulder strong and flexible and reduce the pain and weakness
  • Cortisone steroid injections – reduces inflammation and control the pain. It is advisable to avoid repeated steroid injections in the presence of a tendon tear, as this may weaken the tendon further.
  • Surgery is required – if the tear follows an injury, when pain and weakness is not improved with injections and physiotherapy.

The goal of any surgery is to relieve the pain and improve the shoulder strength. This requires a long period of physiotherapy in addition to the surgery. After a rotator cuff surgery a small percentage of patients experience complications. In addition to the risks of surgery in general, such as blood loss or problems related to anesthesia, complications of rotator cuff surgery may include: nerve injury, infection, deltoid detachment, stiffness, tendon re-tear. Large tears of rotator cuff, approximately 6 in 10 don’t heal with surgery, also a recovery after the surgery is difficult especially in the over 60 group, according to the studies 1 in 3 rotator cuff tears not healing in that age group. The chance that the tendons will heal with surgery is directly related to how large the tear in the tendons was before surgery. Consider all the known researches it is quite reasonable to pay attention to the non-surgical approaches, before trying more invasive surgery that may provide little benefit.

Rotator cuff pain treatment

Our Treatment: Rotator Cuff Treatment and Rehab in NYC

A new study shows that the treatment called “ESWT“ (extracorporeal shock wave therapy) can be very effective in helping a painful rotator cuff. ESWT has been shown by medical studies in some cases may become an alternative to a surgery. ESWT is used for treatment such conditions as chronic shoulder tendinitis, rotator cuff tendinitis paintful rotator cuff tears and many others. This proprietary technology is based on a unique set of pressure waves that stimulate the metabolism, enhance blood circulation and accelerate the healing process. Damaged tissue gradually regenerates and eventually heals. The acoustic waves may help to accelerate the healing process of chronic rotator cuff tendonitis via an unknown mechanism. ESWT is known to accelerate the healing of musculoskeletal tissue. The patient-friendly therapy is ambulatory, gentle, and lasts around 15 minutes. The ability to continue to work and to participate in sport are normally possible the same or the following day. The treatment is usually performed up to three times with an interval of one to two weeks. The goal of any treatment is to reduce pain and restore function. Early treatment can prevent your symptoms from getting worse. It will also get you back to normal life much quicker. At our rehabilitation centre we use combination of physical therapy, exercises and regenerative treatments such as extracorporeal shockwave therapy. Depending on the diagnosis, individualized treatment plans are developed on the individual basis so that each of our clients can be provided with the combination of the most effective therapies.

Redcord Neurac Therapy:
Suspension Training Meets Physical Therapy for Rehab, Fitness and Performance
Your body is a masterpiece of form and function, designed to move in fluid and coordinated patterns governed by your nervous system. But oftentimes, overuse, underuse or abuse of your muscular system can result in pain, injury, uncoordinated movement and poor performance. Thankfully, through proper training and rehabilitation, your miraculous body is able to heal and recoup its natural functional capacity.

About the Author

Dr. Lev Kalika is clinical director of NYDNRehab, located in Manhattan. Lev Kalika is the author of multiple medical publications and research, and an international expert in the field of rehabilitative sonography, ultrasound guided dry needling and sports medicine Dr. Kalika works with athletes, runners, dancers and mainstream clients to relieve pain, rehabilitate injuries, enhance performance and minimize the risk of injuries. His clinic features some of the most technologically advanced equipment in the world, rarely found in a private clinic.

130 West 42 Street Suite 1055, New York NY 10036

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In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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