If you have ever had rotator cuff troubles, you might have heard about rotator cuff tears and discomfort and complications it can cause.  The shoulder joint is the most flexible joint in our body that allows the arm to have an incredible range of motion.  This same advantage of the shoulder joint makes it more vulnerable to injuries and when injury happens the lack of mobility of this important joint can be particularly frustrating and uncomfortable.  While most of the rotator cuff tears need treatment, not all tears are the same.  Considering the importance of shoulder joint in our day-today- life, it is prudent to understand different types of rotator cuff tears for early detection and seeking treatment if you or someone you love is suffering from one.  Let’s first understand the function of rotator cuff muscles.

This pull helps the arm (humerus) move.  Their duty is to provide the power to lift and rotate the arm.  With age, these muscles become thinner and weak, thus prone to tear, even with minimal trauma.  Rotator cuff muscles are usually seen at the junction of the muscle with the tendon, which is the part of the muscle that goes into the bone.

In rotator cuff tears, one or more tendons of rotator cuff can suffer the damage.  If the injury is untreated and activities continue unabated, then the tear may worsen.  It is vital to seek proper treatment to allow the rotator cuff to function optimally.

The different types of rotator cuff tears include:

  • Partial tear
  • Complete tear
  • Acute tear
  • Degenerative tear

The rotator cuff is made up of tendons from the supraspinatus, infraspinatus, teres minor and subscapularis muscles, and plays an important role in the dynamic stability of the shoulder joint.  The rotator cuff muscles contract and pull on the tendons, the tendons then pull on the bone.

Partial rotator cuff tear:

Partial tears of the rotator cuff may be associated with an injury.  In these tears, the muscles that form the rotator cuff is either frayed or damaged.  It generally happens among aging adults as rotator cuff tendons inside the shoulder may wear down with age, which may lead to partial rotator cuff tears.  The other group which is prone to partial tears of the rotator cuff is the people who engage in overhead athletics (playing sports with an upper arm and shoulder arc over the head – cricket, baseball etc).  Partial rotator cuff tears occurred in competitive sports are treated the same as partial tears in aging adults.  There are chances of partial rotator cuff tears going unnoticed because they always don’t generate pain.  It should be noted that a condition called frozen shoulder can mimic the symptoms of partial rotator cuff tear.  Treatment is generally not needed if there is no pain and there are not any associated symptoms.  Surgery is rarely considered in this type of rotator cuff tear.

Complete rotator cuff tear:

Complete rotator cuff tears go all the way through the tendon or pulls the tendon off the bone.  This type of tear is also called full-thickness tear.  It separates the entire tendon from the bone.  In other words, there is complete loss of continuity of one or multiple tendons.  With a complete rotator cuff tear, there is basically a hole in the tendon.  A complete rotator cuff tear can be classified as small, medium, large and massive in accordance with its size.  Complete rotator cuff tears can be effectively treated with injections in the short term and exercise in the intermediate term.

Acute rotator cuff tear:

Acute rotator cuff tears occur in people with no prior history of rotator cuff problems, but there is a traumatic incident leading to a sudden onset of symptoms such as severe pain, immediate loss of strength and functional impairment of the shoulder.  These tears are caused by injury/trauma, such as a fall or lifting something too heavy too quickly or awkwardly.  Acute rotator cuff tears account for 8% of patients who present with symptomatic rotator cuffs.  Correct and early clinical diagnosis is often difficult.  In order to get a good functional recovery post acute rotator cuff tear, it is imperative that it is fixed within three weeks of the injury.  If the tear is severe and there are less chances of success with conservative treatment modalities, then surgical intervention is recommended.

Degenerative rotator cuff tear:

Degenerative rotator cuff tears are common and are a major cause of pain and shoulder dysfunction.  Degenerative tears generally happen in older people (more than 50 years old).  Degenerative tears occur from a gradual wearing down of the tendon over time.  This may happen due to natural aging process (increasing the likelihood of injury over time), genetics or other medical conditions such as diabetes or high cholesterol.  These tears are more common in the dominant arm due to the higher level of repetitive stress it experiences.  Examination may reveal atrophy around the shoulder girdle secondary to chronic disuse, typically in the supraspinatus and infraspinatus fosse.

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Q&As on Types of Rotator Cuff Tears

1) What are the symptoms of degenerative rotator cuff tears?

Small rips in the degenerative rotator cuff may not cause any symptoms. In most cases, discomfort, stiffness, and a lack of strength are brought on by tears that have become bigger over time. Patients who suffer from complete degenerative rotator cuff tears have difficulty carrying out the activities necessary for day-to-day functioning. It may be highly challenging for these individuals to elevate their arms, pick up and hold items, and have trouble gripping things. Receiving a diagnosis is the preliminary step in the process of symptom management.

2) What are the symptoms of partial rotator cuff tears?

Individuals with partial rotator cuff injuries don’t always develop symptoms, but those who do may complain of shoulder aches. Lifting objects above shoulder level or far from the body is often the motion with the most significant discomfort associated with a partial rotator cuff injury. Such lifting puts a lot of strain on the shoulder. Cycling, lifting weights, swimming, and other exercises may not cause any pain. There is no evidence that prolonging the exercise will exacerbate the rupture, but if you feel pain, you could consider reducing it.

3) How is the surgical management of acute rotator cuff tears done?

One may be referred for surgical intervention if tears appear two weeks after the accident or continue to exhibit symptoms while receiving conservative treatment. Also, take into account surgical correction for significant and bigger tears.

Arthroscopy or an open technique may be used to do repairs, allowing a quicker recovery in more enormous tears. The prognosis after surgical repair is often highly favourable. However, individuals with severe or significant rips, age >65, poor compliance with rehabilitation regimens, or current smokers sometimes do not have the best results.

4) How is recovery after complete rotator cuff tear treatment surgery?

The patient should anticipate being less functional than usual for twelve weeks after rotator cuff surgery. After a rotator cuff repair, the shoulder should not be utilised for three months with the elbow extended. Lifting, pushing, tugging, and other everyday actions strain the rotator cuff and may put too much force on the repair, increasing the chance of the repair failing. Driving to stores and carrying out routine tasks might be challenging. Before surgery, arrangements must be made for any required help. Home assistance plans should be planned well in advance for persons who live alone or those who do not have easy access to aid.

5) What are the non-surgical methods to manage degenerative rotator cuff tears?

Rest: You’ll wear a sling or reduce shoulder-related activities.

Nonsteroidal anti-inflammatory medicines: NSAIDs such as ibuprofen might lessen discomfort and swelling.

Physical therapy: Specific exercises may strengthen your shoulder and help you regain your range of motion, flexibility, and a full range of motion. Your fitness regimen may also aid in shoulder pain relief and injury prevention.

Injections: A local anaesthetic or corticosteroid injection may sometimes ease uncomfortable symptoms. Corticosteroid is an anti-inflammatory medicine, and it is one of the most effective ways for managing cuff tear pain. 

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