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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.

Rotator Cuff Tear

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.


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