Rotator Cuff Tear

What is a Rotator Cuff Tear?

A rotator cuff tear is a type of injury where there is a tear of one or more of the tendons of the four muscles of the shoulder that form the rotator cuff.

The rotator cuff is a group of muscles and tendons that help in stabilizing the shoulder and also in movement of the shoulder. This group of muscles and tendons surround the shoulder joint and therefore keeps the head of the upper arm bone firmly within the socket of the shoulder, which is shallow.

Injury to the rotator cuff is quite common although injury usually happens to the tendons more than the muscles.Exerting too much stress on the rotator cuff may cause some tendons to tear, while abrupt stress may cause more than one tendon to pull away.

Causes

Rotator cuff injuries occur most often in people who perform overhead motions repeatedly in their jobs or sports activities. Such overhead motions (degenerative conditions) can cause too much stress or abrupt stress to the shoulder muscles and tendons leading to rotator cuff tears. Injuries to the rotator cuff can happen when:

You fall on your shoulder.
You use your arm to break a fall.
You lift heavy weights.
You experience an accident and you shoulder is forced into an awkward position (acute conditions).

People prone to rotator cuff tears include painters, carpenters, people who play basketball or tennis, swimmers and football players. People over the age of forty are also prone to rotator cuff injuries.

Classification

Rotator cuff injury are grouped into three categories depending on the severity.

Tendinitis

The first category is Tendinitis; this is an injury caused by the over use of the rotator cuff and causes it to become enflamed. This injury is common among tennis players with an overhead serve.

Bursitis

The second category is Bursitis, which is caused by inflammation of the bursa, sacs of fluid that are found between the rotator cuff tendons and the bone.

Rotator cuff tears

The last category is rotator cuff tears or strains which are caused by the overuse of the shoulder muscle or by acute injury to the rotator cuff.

Symptoms

The symptoms of rotator cuff injury include the following:

Inability to sleep on the shoulder.
Snapping or crackling sound when moving the shoulder.
Progressive weakness in the shoulder.
Pain in the shoulder and arm depending on how severe the tear is, ranging from mild pain to acute pain.
Difficulty in achieving full range of shoulder motion.
Tenderness and pain in the shoulder when reaching overhead.
Tendency to avoid certain activities because they are causing you pain.

Despite these symptoms not all rotator cuff injuries cause pain as some are as a result of a degenerative disease which makes presentation of symptoms to be delayed. This happens because damage to the rotator cuff is gradual taking months or even years.

Diagnosis

Medical history, physical exam and imaging scans are used when diagnosing rotator cuff injuries.

History

History: The doctor may ask about conditions at the workplace as a means of determining if the patient has an increased risk of degenerative conditions.

Physical exam

The physical exam will entail the doctor testing the range of motion and strength of the arms in order to rule out other similar conditions such as arthritis or pinched nerve.

Imaging

Imaging scans such as X-rays can help identify small bone growths, bone spurs, which can rub against the tendon causing inflammation. Magnetic resonance imaging (MRI) or ultrasound scans can be used to examine soft tissues such as muscles and tendons, aiding in identifying tears and how severe they have become.

Arthroscopy, this is the insertion of a tiny camera into the shoulder joint through a minimally invasive surgical procedure. This is however usually not done unless it is likely that the rotator cuff can only be repaired surgically.

Treatment

Treatment ranges from resting the affected arm to surgery. Tendinitis can progress to a rotator cuff tear and therefore seeking treatment as quickly as possible keeps the injury from progressing to more severe levels.

Treatments methods that don’t involve surgery improve the symptoms in about 50 percent of the people with rotator cuff tears. Such treatments include:

Using hot or cold packs to apply to the affected parts to reduce swelling
Exercising in order to regain strength and range of motion
Injecting cortisone which is a steroid to the affected part in order to reduce inflammation
Resting the arm that is affected and putting on a sling to isolate arm motions
Consuming some over-the-counter anti-inflammatory medication like Ibuprofen and Naproxen.

Surgery

In this procedure surgeons insert a tiny camera (arthroscope) and special tools through a small incision to reattach the torn tendon to the bone. This is a relatively pain free procedure and usually has a shorter recovery time as it is minimally invasive.
Open tendon repair: In this procedure a surgeon works through a large incision in order to reattach the tendons that have been damaged back to the bone. Such procedures have a longer recovery time than minimally invasive procedures.
Removal of bone spurs- the excess bone can be removed and the damaged portion of the tendon smoothed. This procedure is often performed through arthroscopy which is minimally invasive.
Where the torn tendon has been severely damaged, to reattach to the arm bone, surgeons may decide to use nearby tendons as a replacement.
Severe rotator cuff injuries may require shoulder replacement in order to artificially improve the joint’s stability. Here the ball part of the artificial join is installed onto the shoulder blade and the socket part onto the arm bone.

Conclusion

When involved in a profession or sport that has a high risk of degenerative conditions that cause rotator cuff injuries, the best way to prevent such injuries is to take frequent rest in between. In the event you are injured, apply cold packs or ice on the injured area for about 10 minutes at a time to help reduce swelling and also prevent re-injury.

Exercising prevents occurrence of rotator cuff injuries and should also be done to strengthen the shoulder and encourage range of motion, however a physical therapist should be consulted first.

References

Rotator Cuff Injury. http://www.healthline.com/health/rotator-cuff-injury
Rotator Cuff Tear. http://www.webmd.boots.com/fitness-exercise/guide/rotator-cuff-tear
http://www.mayoclinic.org
http://www.healthline.com/health/rotator-cuff-injury/diagnosis-tratment/treatment/txc-20128411