Shoulder Tendon Tear – Causes, Symptoms & Treatment
A shoulder tendon tear is a partial or complete rupture of one or more tendons in the shoulder, most commonly affecting the rotator cuff. It causes pain and limited range of motion.
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A shoulder tendon tear is a partial or complete rupture of one or more tendons in the shoulder, most commonly affecting the rotator cuff. It causes pain and limited range of motion.
What is a Shoulder Tendon Tear?
A shoulder tendon tear (medically known as a tendon rupture) refers to the partial or complete tearing of one or more tendons in the shoulder joint. The most commonly affected structure is the rotator cuff – a group of four muscles and their tendons that stabilize the shoulder and enable a wide range of movement. The supraspinatus tendon is torn most frequently.
A shoulder tendon tear can occur suddenly due to trauma or gradually due to degenerative wear over time. It is one of the most common shoulder injuries and occurs most often in people over the age of 40 and in athletes.
Causes
There are two primary causes of a shoulder tendon tear:
- Traumatic rupture: A sudden, forceful movement such as a fall onto an outstretched arm, a jerking motion, or a direct blow to the shoulder.
- Degenerative rupture: Gradual wear and tear of the tendon over time, often related to friction, poor blood supply, or age-related tissue changes.
Additional risk factors include:
- Advanced age (significantly more common after age 50)
- Overhead work or overhead sports (e.g., tennis, swimming, handball)
- Smoking (reduces blood flow to tendons)
- Prolonged use of corticosteroid injections
- Pre-existing shoulder conditions such as impingement syndrome
Symptoms
Symptoms of a shoulder tendon tear can vary depending on the severity and type of injury:
- Sudden, sharp pain in the shoulder (in acute tears)
- Persistent, dull aching pain that worsens with movement (in degenerative tears)
- Weakness when lifting the arm or carrying objects
- Reduced range of motion in the shoulder
- Clicking or grinding sounds in the shoulder joint
- Night pain, especially when lying on the affected shoulder
In cases of a complete tear, the patient may be unable to actively lift the arm at all.
Diagnosis
The following methods are used to diagnose a shoulder tendon tear:
- Physical examination: Assessment of strength, range of motion, and pain localization by the physician.
- Ultrasound (sonography): A quick and cost-effective imaging method to visualize tendon changes.
- Magnetic resonance imaging (MRI): The gold standard for accurately assessing the size, location, and extent of the tear, as well as any associated damage.
- X-ray: Used to rule out bony injuries, but cannot directly visualize the tendon itself.
Treatment
Conservative Treatment
Small or partial tears, as well as cases in older patients with lower physical demands, are often treated conservatively first:
- Rest and temporary immobilization of the shoulder
- Pain-relieving medications (e.g., non-steroidal anti-inflammatory drugs, NSAIDs)
- Physiotherapy to strengthen the shoulder muscles and restore mobility
- Corticosteroid injections for short-term reduction of inflammation
Surgical Treatment
Surgery is often recommended for complete tears, younger patients, or cases where conservative treatment has not provided sufficient improvement:
- Arthroscopic reconstruction: Minimally invasive repair of the torn tendon using small instruments through small incisions.
- Open surgery: Required in cases of very large tears or complex injuries.
Following surgery, a rehabilitation period of several months including physiotherapy is typically necessary to restore full shoulder function.
Prognosis
The outlook depends on the size of the tear, the age of the patient, and the treatment approach. Many patients achieve significant improvement in shoulder function with either conservative or surgical treatment. The earlier treatment begins, the better the outcomes tend to be.
References
- German Society for Orthopaedics and Trauma Surgery (DGOU): Rotator Cuff Rupture – Diagnosis and Treatment Guidelines (2021).
- Matthias Flury et al.: Rotator Cuff – Pathology, Diagnostics and Therapy. Springer Medizin, 2020.
- Moosmayer S. et al.: Tendon repair compared with physiotherapy in the treatment of rotator cuff tears. Journal of Bone and Joint Surgery, 2014. PubMed PMID: 24553887.
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