We "shoulder" responsibility and "carry the weight of the world on our shoulders." Perhaps that’s why more than 4 million Americans seek medical care annually for shoulder problems.

One of the most common shoulder problems in middle-aged people is rotator cuff tear. The rotator cuff is comprised of the muscles and tendons surrounding the top of the upper arm bone that hold the bone in the shoulder joint. A tear in this site—usually in the dominant arm-- can result from a single traumatic injury, such as heavy lifting or falling, or it may gradually develop due to repetitive overhead motions, such as pitching or painting a ceiling. Degeneration due to aging may also contribute to the problem.

Signs and symptoms include:

A rotator cuff tear is diagnosed through physical examination and tests that may include X-rays, an arthrogram (in which a dye is injected into the joint before the X-ray is taken), magnetic resonance imaging (MRI) and ultrasound.

Your doctor will prescribe a treatment based on the severity of the injury and your need for pain relief, movement, and function. While full-thickness tears require surgery for correction, less severe partial-thickness tears usually do not, and their treatment may include:

If surgery is required, the procedure may be arthroscopic (done through a small incision) or more extensive open surgery. It takes some time to recover from shoulder surgery, and full function may not return for six months or more. Although each case is unique, surgery and rehabilitation usually restore functional range of motion.

The Health Alliance is a health care provider for the Miami RedHawks, the Cincinnati LadyHawks, University of Cincinnati Bearcats and Northern Kentucky University Norse.