Rotator Cuff Tears and Treatments

Rotator Cuff Tears and Repairs

Rotator Cuff Tears and Treatments

A partial or complete rotator cuff tear makes it difficult to raise and move your arm. You may have shoulder pain and arm weakness. Rotator cuff injuries are common, especially as you get older. Rest, pain relievers and physical therapy can help. Some people need surgery to reattach a torn rotator cuff.

The rotator cuff is a group of muscles and tendons that surround the shoulder joint, keeping the top of your upper arm bone (humerus) firmly within the shoulder blade (scapula) socket. The rotator cuff tendons provide stability to the shoulder, while the muscles allow the shoulder to rotate.

Rotator cuff injuries are extremely common and the rotator cuff is the most common cause of shoulder pain. A rotator cuff injury can cause a dull ache in the shoulder that often radiates down the outside part of the upper arm. When the tendon has a tear, the shoulder becomes weaker and often results in discomfort and difficulty when attempting even the simplest of activities or when just trying to sleep.

While people of all ages can be susceptible to rotator tears, those that seem to be most vulnerable are athletes, particularly rowers, tennis players and baseball pitchers, as well as people who repeatedly perform overhead motions in their job, such as painters and carpenters. Because rotator cuff tears are most frequently caused by “wear and tear” that goes along with aging, people over the age of 40 are at the greatest risk.

Although younger people can experience tears caused by overhead work or frequent athletic activity, the majority of tears in children and young adults are typically a result of some type of traumatic incident, such as a fall or car wreck.

What Is a Rotator Cuff Tear?

A rotator cuff tear is a rip in the group of four muscles and tendons that stabilize your shoulder joint and let you lift and rotate your arms (your rotator cuff). It’s also called a complete tear or a full-thickness tear.

There are two kinds of rotator cuff tears. A partial tear is when one of the muscles that form the rotator cuff is frayed or damaged. The other is a complete tear. That one that goes all the way through the tendon or pulls the tendon off the bone.

It’s a common injury, especially in sports like baseball or tennis, or in jobs like painting or cleaning windows. It usually happens over time from normal wear and tear, or if you repeat the same arm motion over and over. But it also can happen suddenly if you fall on your arm or lift something heavy.

Types of Rotator Cuff Tears

One or more tendons in the rotator cuff may tear, if the injury is untreated and activity continues, then the tear may worsen. It is important to receive proper treatment to allow the rotator cuff to function optimally.

The different classification of rotator cuff tears include:

Partial tear: The tendon of the rotator cuff is damaged, but not completely severed.

Complete tear: The soft tissue is torn into two separate pieces. The tendons frequently tear away from where they are attached at the humerus (upper arm bone).

Acute tear: These tears are caused by injury/trauma, such as a fall or lifting something too heavy too quickly or awkwardly.

Degenerative tear: Most rotator cuff tears are multifactorial in origin and occur from a gradual wearing down of the tendon over time as well as genetics, and other medical conditions such as diabetes or high cholesterol. Because of this, tears are more common in the dominant arm due to the higher level of repetitive stress it experiences. Degeneration also occurs naturally as we age, increasing a likelihood of injury over time.

What Causes A Rotator Cuff Tear?

An accident, such as a fall, can cause a broken collarbone or dislocated shoulder that tears the rotator cuff.

More commonly, rotator cuff tears occur over time as the tendon wears down with age and use (degenerative tear). People over 40 are most at risk.

Causes of degenerative tears include:

  • Bone spurs: Bony growths can form on the top of the shoulder bone. These bone spurs rub against the tendon when you lift your arm. This shoulder impingement creates friction between the bone and tendon. Eventually, a partial or complete tear may occur.
  • Decreased blood flow: Blood flow to the rotator cuff decreases as you get older. Your muscles and tendons need a healthy blood supply to repair themselves. If blood doesn’t nourish the tendons, they can tear.
  • Overuse: Repetitive shoulder movements during sports or on the job can stress muscles and tendons, causing a tear.
  • What are risk factors for rotator cuff tears?

Anyone can experience a rotator cuff tear. These factors may increase your risk:

  • Family history of shoulder problems or rotator cuff injuries.
  • Poor posture.
  • Smoking.
  • Being age 40 or older.

Degenerative tears are more common among people who do the same repetitive shoulder movements, such as:

  • Carpenters.
  • Mechanics.
  • Painters.
  • Recreational and professional athletes who play baseball, softball and tennis or are part of a rowing crew.

What Are The Symptoms Of A Rotator Cuff Tear?

The most common symptoms of a rotator cuff tear include:

  • 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
  • Crepitus or crackling sensation when moving your shoulder in certain positions

Tears that happen suddenly, such as from a fall, usually cause intense pain. There may be a snapping sensation and immediate weakness in your upper arm.

Tears that develop slowly due to overuse also cause pain and arm weakness. You may have pain in the shoulder when you lift your arm, or pain that moves down your arm. At first, the pain may be mild and only present when lifting your arm over your head, such as reaching into a cupboard. Over-the-counter medication, such as aspirin or ibuprofen, may relieve the pain at first.

Over time, the pain may become more noticeable at rest, and no longer goes away with medications. You may have pain when you lie on the painful side at night. The pain and weakness in the shoulder may make routine activities such as combing your hair or reaching behind your back more difficult.

It should be noted that some rotator cuff tears are not painful. These tears, however, may still result in arm weakness and other symptoms.

How Is A Rotator Cuff Tear Diagnosed?

To find out if you have a torn rotator cuff, your doctor will start with a history of the injury and a physical examination of the shoulder. During the exam, they’ll check your range of motion and muscle strength. They’ll also see what movements make your shoulder hurt.

In addition, your doctor may use one of the following:

  • MRI, which uses radio waves and a powerful magnet to make detailed pictures of your shoulder.
  • X-rays to see if the top of your arm bone (humeral head) is pushing into your rotator cuff space.
  • Ultrasound to see the soft tissues (tendons, muscles, and the bursas) in your shoulder

Rotator Cuff Tear Treatment

Your doctor is likely to start with a combination of several treatments including:

  • Physical therapy to make your shoulder muscles stronger
  • Medications like acetaminophen and anti-inflammatory drugs to help with pain and swelling
  • You also may get exercises to do at home and suggestions that help you use your shoulder in safer, more comfortable ways in your day-to-day life.
  • Rest to allow your rotator cuff to heal
  • Steroid injections into your shoulder joint, which can provide temporary pain relief

If those don’t work, you may need surgery, especially if you have a complete tear. It’s likely your doctor will need to stitch together the torn area or reattach the tendon to the bone.

In some cases, they might need to take out small pieces of tendon or bone that are stuck in your shoulder joint, or remove small areas of bone or tissue to give your tendon more room to move.

Types of rotator cuff surgery:

  • Arthroscopic. Your doctor will make a small cut in your shoulder then use an arthroscope — a tube with a small camera and tiny instruments — to fix the tear. This means your recovery time will likely be shorter than it would with another type of surgery.
  • Open. Your doctor uses larger instruments to go into the muscles of your shoulder and fix the tear.
  • Mini-Open. This uses both arthroscopic and open methods. Your doctor starts with the arthroscope and finishes with larger instruments.
  • Tendon transfer. If your tendon is too torn to reattach, the doctors can use another nearby tendon.
  • Shoulder replacement. If the rotator cuff tear is large enough, you may need to have your shoulder joint replaced.

Rotator Cuff Tear Prevention

To prevent a rotator cuff tear, it’s important to keep your muscles and tendons flexible. Your healthcare provider can teach you stretching and strengthening exercises to do at home.

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Rotator Cuff Injuries and Treatments

Rotator Cuff Injuries and Treatments

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