The rotator cuff is a network of four muscles (supraspinatus, Infraspinatus, Teres Minor and Subscapularis) that come together as tendons to form a covering around the head of the humerus. The rotator cuff attaches the humerus to the shoulder blade and helps to lift and rotate your arm.
A torn rotator cuff will weaken your shoulder. This means that many daily activities, like combing your hair or getting dressed, may become painful and difficult to do.
When one or more of the rotator cuff tendons is torn, the tendon no longer fully attaches to the head of the humerus. Most tears occur in the supraspinatus muscle and tendon, but other parts of the rotator cuff
may also be involved.
Types of tears
1) Partial Tear
This type of tear damages the soft tissue, but does not completely sever it.
2) Full-Thickness Tear
This type of tear is also called a complete tear. It splits the soft tissue into two pieces. The part closer to the muscle belly may get retracted over a period of time, making the repair more difficult.
3) Acute Tear
If you fall down on your outstretched arm or lift something too heavy with a jerking motion, you can tear your rotator cuff. This type of tear can occur with other shoulder injuries, such as a broken collarbone or dislocated shoulder.
4) Degenerative Tear
Most tears are the result of a wearing down of the tendon that occurs slowly over time. This degeneration naturally occurs as we age. Rotator cuff tears are more common in the dominant arm.
Several factors contribute to degenerative, or chronic, rotator cuff tears.
- Repetitive stress. Repeating the same shoulder motions again and again can stress your rotator cuff muscles and tendons. Baseball, tennis, rowing, and weightlifting are examples of sports activities that can put you at risk for overuse tears. Many jobs and routine chores can cause overuse tears, as well.
- Lack of blood supply. As we get older, the blood supply in our rotator cuff tendons lessens. Without a good blood supply, the body's natural ability to repair tendon damage is impaired. This can ultimately lead to a tendon tear.
- Bone spurs. As we age, bone spurs (bone overgrowth) often develop on the underside of the acromion bone. When we lift our arms, the spurs rub on the rotator cuff tendon. This condition is called shoulder impingement, and over time will weaken the tendon and make it more likely to tear.
- Pain at rest and at night, particularly if lying on the affected shoulder.
- Pain when lifting and lowering your arm or with specific movements.
- Weakness when lifting or rotating your arm.
Clinical Signs :
- Weakness of Shoulder
- Loss of Active movement
- Complete Passive Movement Present
- Positive Drop Arm Test
MRI of the shoulder is a Gold Standard for Rotator Cuff Tears
Nonsurgical Treatment :
In about 50% of patients, nonsurgical treatment relieves pain and improves function in the shoulder. Shoulder strength, however, does not usually improve without surgery.
Nonsurgical treatment options may include :
- Rest. Your doctor may suggest rest and and limiting overhead activities. He or she may also prescribe a sling to help protect your shoulder and keep it still.
- Activity modification. Avoid activities that cause shoulder pain.
- Non-steroidal anti-inflammatory medication. Drugs like ibuprofen and naproxen reduce pain and swelling.
Strengthening exercises and physical therapy.
Specific exercises will restore movement and strengthen your shoulder. Your exercise program will include stretches to improve flexibility and range of motion. Strengthening the muscles that support your shoulder can relieve pain and prevent further injury.
Surgical Treatment :
All-Arthroscopic Repair :
During arthroscopy, your surgeon inserts a small camera, called an arthroscope, into your shoulder joint. The camera displays pictures on a television screen, and your surgeon uses these images to guide miniature surgical instruments.
Because the arthroscope and surgical instruments are thin, your surgeon can use very small incisions (cuts), rather than the larger incision needed for standard, open surgery.
All-arthroscopic repair is usually an outpatient procedure and is the least invasive method to repair a torn rotator cuff.