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The main stabilizers of the shoulder are the rotator cuff tendons which are key to a healthy functioning shoulder. Tendons attach muscles to bones and muscles move the bones by pulling on the tendons. The rotator cuff helps raise and rotate the arm. The rotator cuff also keeps the humerus tightly in the socket of the scapula as the arm is moved. Rotator cuff tendons are subject to a lot of wear and tear, or degeneration, as we use our arms. Tearing of the rotator cuff tendons is an especially painful injury. A torn rotator cuff creates a very weak shoulder. Most of the time patients with torn rotator cuffs are in late middle age. But rotator cuffs tears can happen at any age. 

Causes

The rotator cuff tendons have areas of very low blood supply. The more blood supply a tissue has, the better and faster it can repair and maintain itself. The areas of poor blood supply in the rotator cuff make these tendons especially vulnerable to degeneration from aging. This problem of degeneration may be accelerated by repeating the same types of shoulder motions. This can happen with overhand athletes, such as baseball pitchers. But even doing routine chores like cleaning windows, washing and waxing cars, or painting can cause the rotator cuff to fatigue from overuse. Excessive force can tear weak rotator cuff tendons. This force can come from trying to catch a heavy falling object or lifting an extremely heavy object with the arm extended. The force can also be from a fall directly onto the shoulder. Sometimes injuries that tear the rotator cuff are painful, but sometimes they aren't. Researchers estimate that up to 40 percent of people may have a mild rotator cuff tear without even knowing it. The typical patient with a rotator cuff tear is in late middle age and has had problems with the shoulder for some time. This patient then lifts a load or suffers an injury that tears the tendon. After the injury, the patient is unable to raise the arm. However, these injuries also occur in young people. Overuse or injury at any age can cause rotator cuff tears.

Symptoms

Rotator cuff tears cause pain and weakness in the affected shoulder. In some cases, a rotator cuff may tear only partially. The shoulder may be painful, but you can still move the arm in a normal range of motion. In general, the larger the tear, the more weakness it causes. In other cases, the rotator cuff tendons completely rupture. A complete tear makes it impossible to move the arm in a normal range of motion. It is usually impossible to raise the arm away from your side by yourself. Most rotator cuff tears cause a vague pain in the shoulder area. They may also cause a catching sensation when you move your arm. Most people say they can't sleep on the affected side due to the pain.

Treatment

Initially, your physical therapy treatments will focus on reducing the pain and inflammation that have resulted from the injury. In addition, your therapist will utilize various hands on techniques and exercises to improve the shoulder range of motion as well as the strength around the entire shoulder complex. As the range of motion improves the treatments will focus more on continuing to improve the control and the strength of the shoulder as well as the shoulder blade. The course of treatment may last 1-2 months, and will depend on the extent of the injury and the progress that is made during treatments. Your therapist will guide you in your home exercise program as well as activities that you can and can not do as you progress through your treatment course.