Rotator Cuff Tear
Rotator cuff tear is the most common cause of pain in the shoulder among adults. At least 2 million people suffer from this every year. It is more common in people who repetitively perform overhead motions like painters, carpenters, heavy weight lifters, and swimmers. The injuries become more frequent in old age.
Rotator cuff tear causes soreness in the shoulder and with time can become unbearable, restricting the range of motion and functionality of the shoulder.
What is Rotator Cuff Tear?
The rotator cuff is composed of muscles and tendons that surround the shoulder joint. It keeps the head of the upper arm firmly in place within the socket of the shoulder. These muscles and tendons provide flexibility, strength, and stability to the shoulder.
When at least two tendons are completely torn, the injury occurs. When the tendon is torn, it is no longer attached to the head of the humerus.
There are different types of tears that fall into either of these two categories:
- Partial tear: Also known as an incomplete tear. It does not completely tear the tendon but damages it partially.
- Full-thickness tear: Also known as a complete tear. It completely separates the tendon from the bone. There is a hole in the tendon in this type of tear.
The process of tear begins with the tendons fraying and over a duration, it gets completely torn.
The tear can also be further classified on the basis of size, location, and shape.
What causes Rotator Cuff tear?
Rotator cuff tear can be the result of activities with repetitive overhead motions or degeneration of the tendons over a period of time.
Lack of blood supply in the rotator cuff as we get older. Lesser blood supply prohibits the body’s ability to heal the tendon naturally. Bone overgrowth on the underside of the acromion bone causes it to rub against the rotator cuff tendon. This weakens the tendon and over time it will tear.
There are two main causes of rotator cuff tear:
- Acute tear: Sudden fall on the outstretched arm or lifting something heavy can cause the rotator cuff to tear.
- Degenerative tear: Damage to the tendons over time. Degeneration is a natural occurrence in the tendons and muscles as age increases.
An acute tear happens because of one particular incident whereas a degenerative tear happens over a period of time and the effects are not seen immediately.
What are the symptoms of Rotator Cuff Tear?
Rotator cuff tear causes pain in the shoulder and upper arm. It is most observable when the arm is lifted to the top. The tendons rub against the structures around it.
Symptoms also include:
- Full of range of motion in the shoulder is difficult to attain
- Pain in the affected area if slept on it
- Weakness in the muscles around the affected shoulder
- Weakness in the shoulder, limiting its functionality
- Difficulty using the shoulder to even lift objects as it causes immense pain.
It is to be noted that some patients suffering from rotator cuff tear do not show any symptoms.
Diagnosis of Rotator Cuff Tear
The doctor will ask for your medical history and look into symptoms. The doctor will then carry out a physical examination of the affected shoulder. They will check for tenderness and deformity in the shoulder. They will assess the range of motion your shoulder can perform and will also test arm strength.
X-rays do not show tendons or any soft tissues but are recommended to see if there is any bone overgrowth in the shoulder.
MRIs or ultrasound are suggested as a tear in the tendons and the location of it can be seen. MRI can also show the doctor how old or new the tear is as it shows the quality of the tear in the muscle.
Treatment for Rotator Cuff Tear
There are numerous treatment options available ranging from nonsurgical to surgical.
Nonsurgical treatments include
- Applying hot or cold packs to the affected area to reduce swelling
- Physical therapy to strengthen the muscles and restore range of motion to its full function
- Injecting the affected area with steroids to reduce inflammation
- Wearing a sling to isolate range of motion for a certain duration
Surgical treatments are an option of last resort when the pain is not subsiding. This includes superior capsule reconstruction, reverse total shoulder arthroplasty, acromioplasty, partial RC repair, muscle or tendon transfer.
Non-surgical method has proven to be effective in 80% of the patients. Surgical treatment in elderly patients has shown a high failure rate.
Recovery with proper treatment will take up to four or six weeks to improve the condition. Injections speed up the process. It is advised to not use the affected shoulder. Elderly patients are more prone to rotator cuff tears and have a hard time recovering.