Rotator Cuff Tear

To understand a Rotator Cuff Tear, we must first understand what is a Rotator Cuff. A Rotator Cuff is a group of four small muscles and tendons that surround the shoulder joint and helps in stabilizing the shoulder to perform functions like lifting and rotating your arm. When your Rotator Cuff muscles work in isolation, they exhibit rotational motion at the shoulder joint – hence the name Rotator Cuff. These muscles arise from the scapula and connect to the head of the humerus, forming a cuff at the shoulder joint. The four muscles of the rotator cuff are the supraspinatus muscle, the infraspinatus muscle, teres minor muscle and the subscapularis muscle.

Rotator Cuff Tear or Rotator Cuff Injury or Rotator Cuff Syndrome is a tear of one or more of the tendons of the rotator cuff muscles. It is among the most common injuries of the shoulder and occurs generally in people who perform repeated overhead motions or forceful pulling motions. It is common with people playing baseball, football, rugby, volleyball, polo, swimming, shortput etc and in boxers, weightlifters, martial artists etc. Rotator cuff tear can range from mild to severe with limited pain and movement of the arm to complete loss of motion of the arm.

Symptoms of Rotator Cuff Tendonitis

Symptoms of Rotator Cuff Tear includes pain and inflammation in the shoulder. Pain often radiates down the shoulder. Overhead movements become difficult and it is often painful and difficult to sleep on the side of the injured shoulder. There is also pain lifting your hand or with specific movements. Crackling sounds when moving the shoulder in specific directions. The pain might be mild in the beginning and increases when the tear progresses. In some cases, it reaches a point where the normal functions of the shoulder become extremely difficult.

Causes of Rotator Cuff Injury

It is important to understand the cause of Rotator Cuff Tear, which helps in the right course of treatment. Rotator Cuff Tear can occur mainly in two ways – one is due a sudden fall or lifting something very heavy or a rapid twisting in the shoulder. The other cause is due to wearing down of the tendon that occurs slowly over time (degenerative process). The wearing down of the tendons can occur due to many reasons as follows:

1. Repetitive motions
2. Lack of blood supply – This is due to ageing where the blood supply to the rotator cuff tendons reduces hence impairing the natural process of repair.
3. Bone spurs – This is also due to ageing where the bones form some overgrowth. These overgrowths called spurs rub on the shoulder tendons thus causing Shoulder Impingement.

Diagnosis of Rotator Cuff Tear

A Shoulder Specialist diagnoses a rotator cuff injury using one or more of the following methods:

• Physical examination of the patient
• X-rays
• Arthrogram – which involves injecting contrast dye into the shoulder joint to detect any leakage out of the injured rotator cuff.
• Ultrasound
• MRI

Treatment of Rotator Cuff Injury

It is best to get your rotator cuff treated early. If one keeps continuing activities with shoulder pain, there are chances of the tear becoming larger and severe.

The treatment of rotator cuff tear will depend on the severity of the injury to the tendons. Depending on the condition, your shoulder doctor will recommend the best treatment suited for you. Mild injuries will be treated using rest, anti-inflammatory medicines and physiotherapy in that order as necessary.

Cases where the shoulder pain is persistent and the arm has limited mobility – cortisone injections are given around the rotator cuff.

More severe rotator cuff disease, where non-surgical methods does not help in reducing the pain, will require surgery. Generally, patients who require surgery will have pain in the night and will have limited movement of the arm. Surgery can be done either arthroscopically or using open surgical techniques. Many different types of surgeries are available depending on the type of rotator cuff injury which includes arthroscopic tendon repair, open tendon repair, bone spur removal, shoulder replacement and tendon transfer.

The goals of the treatment aim at relieving pain and restoring the normal functions of the shoulder. Once the course of treatment is complete, doctor will recommend a suitable rehabilitation program.

Importance of physical examination in rotator cuff tear:

 
After listening to your issues, the doctor will start examining your shoulder joint to find out if you are having any of those typical symptoms that can be attributed to rotator cuff tear.  Doctor will palpate different areas of your shoulder joint to see if there is pain and tenderness or if there is any deformity.  You may also be asked to move your shoulder joint in different directions to check the range of motion of your shoulder.  To gauge the strength of the shoulder and arm, doctor may ask you to press against his/her hand.  The doctor may also examine your neck to look for other associated symptoms such as pinched nerve or to rule out other conditions like arthritis as they also mimic the same set of symptoms.

After evaluating and confirming your shoulder condition, your doctor may go in for appropriate treatment methodology as he/she deems fit.  Here, let’s familiarize ourselves with some of the conventional/non-surgical methods that would help regain your lost shoulder health and range of motion.

Importance of physical therapy in rotator cuff tear:

 
Physical therapy includes both active and passive set of exercises to help restore flexibility of the joint and ease pain.  The principal objective of physical therapy treatment is to restore your normal motion of the shoulder without pain.  Physical therapy generally focuses on stretching exercises to improve the flexibility, agility and strength of the shoulder.  If you have tear of the posterior capsule of the shoulder, it would be difficult for you to reach behind your back.  Targeted exercises of the posterior capsule can be very beneficial in relieving pain and discomfort in the shoulder.  Strengthening program for rotator cuff muscles are generally taken as a secondary step after reduction of pain in the shoulder.

Steroid shots:

If the rotator cuff pain and symptoms are recalcitrant to conventional treatment modalities like rest, medications and physical therapy, an injection of a local anesthetic anti-inflammatory medicine may provide relief.  Injection is given into the bursa beneath the acromion (bony process on the shoulder blade).

Importance of rehabilitation after shoulder surgery:

 
If you had shoulder surgery to get rid of rotator cuff tear, make sure you follow proper rehabilitation protocol given to you by the surgeon.  You arm may be placed in a sling for a short period of time.  This will aid faster healing.  As the healing progresses, the doctor will remove the sling.  Rehabilitation is fashioned in line with the type of surgery carried out.  A complete rehabilitation protocol would range anywhere between two to four months.

Relationship between shoulder pain and rotator cuff tear:

Shoulder pain is something that is very common.  Our shoulder is made up of several smaller joints (in fact, it makes our shoulder the most flexible joint of our body!) combined with several tendons and muscles that aid in the greater flexibility of the joint.  The advantage of greater flexibility of the joint may become the very disadvantage of the joint as well as it is vulnerable to different injuries.  The rotator cuff tear can become a frequent cause of pain in the shoulder region.

Our shoulder joint moves smoothly because of the proper function of many muscles and tendons.  Rotator cuff tear adversely affects the movement of these tissues.  Having a rotator cuff tear means your rotator cuff tendons are irritated or torn.  What is to be understood is that this condition can happen either all of a sudden or over a period of time and the trigger could be lack of movement of the shoulder, sleeping on one side of the shoulder for a long time or participation in activities that require overhead motion of the arm.  At times, rotator cuff tear can happen without any apparent trigger.  With proper treatment and rehabilitation, people can resume their activities of daily living without pain.

Some home care tips to keep rotator cuff tear at bay:

You can do a host of things to help reduce pain and discomfort arising out of rotator cuff tear.  These techniques also help prevent further flaring up of the condition.  Some of them are the following:

• Adopt proper posture while sitting
• If you have to repeatedly lift your arm over your head, don’t do it in one go and break that activity into different modules
• Make sure you don’t sleep on the same side of the shoulder every night
• Avoid carrying a bag on only one shoulder
• Carry things close to your body
• Stretch your shoulder during the course of the day. It would boost not only your shoulder health, but kick out your monotony as well

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