Can a Rotator Cuff Tear Cause Numbness in the Hand?

Introduction

Arm pain and hand numbness are common complains in the orthopedic world. Often patients come in with multiple problems including arm pain and hand numbness. So this raises the question can all of the symptoms be related to one problem? That is why we have to answer the question. “Can a rotator cuff tear cause numbness in the hand?”

The short answer to this question in probably not. When a rotator cuff tear occurs it typically spares the nerves in the shoulder. Most of the major nerves of the arm going down to the hand are not close to the rotator cuff. Now there are very rare occasions where these nerves are injured too. So the real questions are, what are the typical symptoms of a rotator cuff tear ?and what are the common conditions that result in hand numbness?

The Rotator Cuff

Rotator cuff muscles are four muscles that are responsible for keeping the shoulder stable. The shoulder joint can be described as a ball and socket joint. This means that the ball found at the upper arm bone fits into the socket at the scapula (shoulder blade). This configuration of joint formation, which is unlike many others, confers great mobility on the shoulder. This great mobility comes with increased pressure and an increased need for stability and protection. This is what the rotator cuff muscles do. Within this joint, the arm can make movements in all directions. Upward and outward, upward and inward, internal and external rotation, abduction (away from the body), adduction (toward the body).

Anatomy of the Four Rotator Cuff Muscles

The muscles of the rotator cuff include the supraspinatus, infraspinatus, teres minor, and the subscapularis. The function of each of the muscles differs but all in a bid to stabilize the joint.

Supraspinatus muscle is responsible for internal rotation and upward movement of the arm when throwing an object forward.
Infraspinatus allows for external rotation of the arm for instance when passing an object along to a person positioned adjacent to you
Subscapularis controls the movement of the arm away from the body, in stretching out to the side
Teres minor controls movement of the arm toward the body

The supraspinatus originates from the supraspinatus fossa and attaches to a prominence on the arm upper humerus called the greater tuberosity. The infraspinatus originates from the infraspinous fossa and attaches to the greater tuberosity just behind the supraspinatus. The teres minor originates from the edge of the scapula to attach to the very back of the greater tuberosity. The subscapularis originates from the subscapular fossa and attaches to the upper humerus at the lesser tuberosity. All the rotator cuff muscles end in a tendon. Tendons are broadband of thickened tissues that attach muscles to bone. The subscapularis has the largest tendon of all the muscles. It contributes the most to the strength of the cuff. There is a fibrous capsule at the shoulder joint. It completely encircles the shoulder joint. It contains fluid that helps to lubricate the joint.

can a rotator cuff tear cause hand numbness — Anatomy of the Rotator cuff

Rotator Cuff Tears

A rotator cuff tear may happen suddenly upon sudden application of extreme force. Such as grabbing on to a railing to help stop a slip and fall. This body weight load on an outstretched arm is a very common mechanism for traumatic tears. The effect of this fall creates a greater load on your rotator cuff muscles causing a tear. Common symptoms are inability to raise the hand, popping, and pain. Others include shoulder weakness, pain at the shoulder joints. A major cause of the tear injury could be as a result of sporting activities. Examples of such sporting activities include baseball and tennis.

A rotator cuff tear may also happen gradually over time. This is typical of some jobs that may require climbing and reaching. Examples include painting or cleaning high-placed windows.

Rotator cuff tears can be classified into 4 main types. The type of tear can determine the resultant complication which includes numbness/pain in the hand. This is because the direction of the tear can affect specific tissues and not necessarily the entire component of the rotator cuff. The entire health of an individual can play a role in the determination of a rotator cuff tear. The fragility of the tendons and soft tissues can also determine the extent of the tear.

The types of rotator cuff tear include:

Partial tear: This is damage to a tendon that holds the rotator cuff in place. It is however not completely severed and most times not associated with numbness/pain of the hand. Each of the rotator cuff muscles has a specific tendon associated with them. A partial tear in one or some of the tendons usually have less symptoms than a full thickness tear.

Complete tear: A complete tear occurs when there is a total tear in the tendons and soft tissue. The anchorage capacity of the rotator cuff is therefore compromised. More often than not, this will result in weakness in the upper arm. Patients who have this type of rotator cuff tear often fall directly on their arms. There could be several other complications such as bicep tendon injury and bone fractures.

Degenerative tear: A rotator cuff tear is not often due to a straightforward cause. It sometimes could be related to multifactorial reasons. In degenerative tears, there is not always an underlying etiology associated with the tear. This could be due to aging or other systemic medical conditions. These conditions can result in the fragility of the tendons and susceptibility of the surrounding soft tissue to damage. A degenerative tear often occurs in the more dominant arm. The dominant arm has been subjected to more stress over time, this, therefore, has more tendency to tear than the non-dominant arm. This type of tear occurs more commonly in the older population. This is primarily due to aging. Just like every other tendon and tissue in the body, there is more susceptibility to a tear with age. A small degenerative rotator cuff tear can be asymptomatic. No pain, numbness, or loss of function.
Rotator cuff tendonitis: An injury to the rotator cuff can have other consequences including damage without a tear. This is called rotator cuff tear is tendonitis. A tendon connects a muscle to its attaching bone. Each of the rotator cuff muscles has its tendons as they attach to the bone directly. In the case of a rotator cuff tendonitis there is inflammation of the tendon.. A rotator cuff tear can also result in the inflammation of the bursa, known as bursitis. A bursa is a sack filled with liquid that acts as a cushion between a tendon and the bone. This cushioning effect prevents unnecessary frictional forces to act between the tendon and the bone.

What can cause numbness in the hand?

To answer this question, it is important to understand several causes of numbness/pain in the hand. It is possible to have numbness/pain in the hand when a rotator cuff tear occurs but this is extremely rare. We will explore the most common reasons for hand pain/numbness

Numbness or pain in the hand is a complication associated with rotator cuff tear. This is not a common complaint seen in patients with a rotator cuff tear. In a very significant rotator cuff tear, especially in trauma, there could be an injury to nerves. This occurs rarely, when the shoulder dislocates (comes out of the socket) tearing the rotator cuff and damaging the nerves. It is important to note that in this situation the rotator cuff tear does not cause the nerve injury, the dislocation of the shoulder causes it.

Common causes of hand pain and numbness

The nerves responsible for sensation in the hand are the median, ulnar and radial nerves. These nerves are branches of the brachial plexus that supply the entire upper limb.

The radial nerve for example supplies the posterior aspect of the upper limb extending down the arm and a small portion of the hand. An injury to this nerve can result in numbness and weakness of the arm, forearm, and a small area of the hand.

The median nerve supplies sensation to the thumb side of the hand. This is a very common problem of numbness in the hand when the nerve is pinched at the wrist. This is called Carpal Tunnel Syndrome (CTS). CTS is probably the most common reason for numbness in the hand.

An injury to the ulnar nerve causes numbness to the pinky side of the hand and most often a result of a pinched nerve at the elbow. Many people refer to the ulnar nerve as the “funny bone” nerve.

Lastly, a nerve can be pinched in the neck causing pain and numbness down the arm into the hand. This is call cervical (neck) radiculopathy (pain/numbness down the path of the nerve).

A fall that results in a traumatic injury to the rotator cuff, can also injure other structures in the arm and neck.

Pain as a major presentation with rotator cuff tear occurs mainly in the arm. This pain can radiate down to the forearm and arm. Typically this pain does not cross the elbow.

Conclusion

If you are having pain and numbness in your hand without a traumatic event it is most likely not related to the rotator cuff tear. So, can a rotator cuff tear cause numbness in the hand? Probably not. The typical symptoms of a rotator cuff tear are pain and weakness in the upper arm. If you are having numbness in the hand it is most likely from a pinched nerve in the upper extremity and not a rotator cuff tear.

The best way to help sort it all out is to see a doctor who specializes in orthopedics. They can evaluate and come up with a treatment plan tailored to your specific problem.

References

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