Rotator cuff tear is a common cause of pain and disability in the adult population. The rotator cuff is made up of four muscles and their tendons. These combine to form a “cuff” over the upper end of the arm (head of the humerus). The four muscles – supraspinatus, infraspinatus, subscapularis, and teres minor – originate from the “wing bone”(scapula), and together form a single tendon unit. This inserts on the greater tuberosity, which is the ball of the arm bone (humerus). The rotator cuff helps to lift and rotate the arm and to stabilize the ball of the shoulder within the joint. Most tears occur in the supraspinatus but other parts of the tendon may be involved.
Rotator cuff tear is most common in people who are over the age of 40. It may occur in younger patients following acute trauma or repetitive overhead work or sports activity. Common examples are: 1.) Workers who do overhead activities such as painting, stocking shelves or construction
2.) Athletes such as swimmers, pitchers and tennis players
A cuff tear may also happen with another injury to the shoulder, such as a fracture or dislocation.
Symptoms of a rotator cuff tear may develop acutely or have a more gradual onset. Acute pain usually follows trauma such as a lifting injury or a fall on the affected arm. More commonly, the onset is gradual and may be caused by repetitive overhead activity or by wear and degeneration of the tendon. You may feel pain in the front of your shoulder that radiates down the side of your arm. At first the pain may be mild and only present with overhead activities such as reaching or lifting. It may be relieved by over-the-counter medication such as aspirin or ibuprofen. Over time the pain may become noticeable at rest or with no activity at all. There may be pain when you lie on the affected side and at night. Other symptoms may include stiffness and loss of motion. You may have difficulty using your arm to reach overhead to comb your hair or difficulty placing your arm behind your back to fasten a button.
When the tear occurs with an injury, there may be sudden acute pain, a snapping sensation and an immediate weakness of the arm.
Diagnosis of a rotator cuff tear is based on your symptoms, your doctor’s examination, X-rays, and imaging studies such as MRI (magnetic resonance imaging). Your doctor will examine your shoulder to see if it is tender in any area or if there is a deformity. He or she will measure the range of motion of your shoulder in several different directions and test the strength of your arm.
Signs of a rotator cuff tear may include:
-Atrophy or thinning of the muscles about the shoulder
-Pain when you lift your arm
-Pain when you lower your arm from a fully raised position
-Weakness when you lift or rotate your arm
-Crepitus or crackling sensation when you move your shoulder in certain positions
Once a diagnosis of rotator cuff tear has been made, your orthopedic surgeon will recommend the most effective treatment. In many instances, non-surgical treatment can provide pain relief and can improve the function of your shoulder.
Treatment options may include:
Rest and limited overhead activity
Activity, work, exercise modification
Use of a sling
**It may take several weeks or months to restore the strength and mobility to your shoulder.
Treatment Options: Surgical
Your orthopedic surgeon may recommend surgery if nonoperative treatment does not relieve your symptoms. Surgery may also be considered if the tear is acute and painful, if it is the dominant arm of an active individual or if you need maximum strength in your arm for overhead work or sports.
The type of surgery performed depends on the size, shape and location of the tear. A partial tear may require only a trimming or smoothing procedure called a “debridement.” A complete tear within the substance of the tendon is repaired by suturing the two sides of the tendon. If the tendon is torn from its insertion on the greater tuberosity of the humerus, it can be repaired directly to bone.
Many surgical repairs can be done on an outpatient basis.
After surgery, the arm is immobilized to allow the tear to heal. The length of immobilization depends upon the severity of the tear. You may begin physical therapy as soon as 2 weeks from surgery to help regain motion and strength in the shoulder. Sometimes therapy doesn’t begin until 6 weeks from surgery to allow time for healing. This begins with passive motion. It advances to active motion and resistive exercises. Complete recovery may take several months. A strong commitment to rehabilitation is important to achieve a good surgical outcome. The doctor will advise you when it is safe to return to overhead work and sports activity.