What is a Rotator Cuff Tear?
A rotator cuff is the group of tendons in the shoulder joint providing support and enabling wider range of motion. Major injury to these tendons may result in tear of these tendons and the condition is called as rotator cuff tear. It is one of the most common causes of shoulder pain in middle aged adults and older individuals.
Causes of Rotator Cuff Tear
Rotator cuff tear results from pressure on the rotator cuff from part of the shoulder blade (scapula) as the arm is lifted. It may occur with repeated use of arm for overhead activities, while playing sports or during motor accidents.
Symptoms of Rotator Cuff Tear
Rotator cuff tear causes severe pain, weakness of the arm, and crackling sensation on moving shoulder in certain positions. There may be stiffness, swelling, loss of movements, and tenderness in the front of the shoulder.
Diagnosis of Rotator Cuff Tear
Your surgeon diagnoses Rotator Cuff Tear based on the physical examination, X-rays, and imaging studies, such as MRI. Rotator cuff tear is best viewed on magnetic resonance imaging.
Conservative Treatment Options for Rotator Cuff Tear
- Shoulder sling
- Pain medication Injection of a steroid (cortisone) and a Local anesthetic in the subacromial space of the affected shoulder to help decrease the inflammation and pain
- Certain Exercises
Surgery for Rotator Cuff Tear
Rotator cuff repair may be performed by open surgery or arthroscopic procedure. In arthroscopy procedure space for rotator cuff tendons will be increased and the cuff tear is repaired using suture anchors. These anchor sutures help in attaching the tendons to the shoulder bone. Following the surgery, you may be advised to practice motion and strengthening exercises.
Rotator Cuff Pain
Normal Anatomy of the Rotator Cuff
The rotator cuff consists of a group of tendons and muscles that surround and stabilize the shoulder joint. These tendons allow a wide range of movement of the shoulder joint across multiple planes. Irritation or injury to these tendons can result in rotator cuff pain.
Causes of Rotator Cuff Pain
Rotator cuff pain may be caused due to:
- Age-related wear and tear of the rotator cuff tendons in the shoulder
- Repeated overhead arm movements as performed during manual labor
- Sports activities such as pitching during baseball or playing racquet sports
- Trauma such as accidents, direct blows to the shoulder, or falling on the shoulder
Symptoms of Rotator Cuff Pain
The symptoms that often accompany rotator cuff pain include:
- Weakness of the shoulder
- Restricted range of motion
Rotator Cuff Pain Exacerbating Factors
Shoulder pain may be exacerbated by:
- Overhead movements
- Reaching behind the back
- Lifting objects
- Lying on the injured shoulder during sleep
Diagnosis of the Cause of Rotator Cuff Pain
Your doctor will make a diagnosis based on:
- History of symptoms
- Medical history
- Physical exam
- X-rays to identify any bony abnormalities that might be irritating the rotator cuff
- MRIs or ultrasounds, which produce better images of the rotator cuff tendons
Treatment of Rotator Cuff Pain
Initial treatment involves the use of conservative methods such as rest, non-steroidal medications, physical therapy and steroid injections.
If the rotator cuff pain is not resolved by conservative methods, surgery may be required.
The goal of surgery is to
- Remove any bony structures or tissue that may be impinging the rotator cuff tendons during movement and causing pain
- Repair/reattach a torn rotator cuff tendon
This can be done arthroscopically (keyhole surgery) or through open surgery.
Following surgery, your arm will be placed in a sling to allow the shoulder time to heal without any stress being placed on it. Once sufficiently healed, physical therapy rehabilitation may be recommended by your doctor to regain strength and range-of-motion.
Prevention of Rotator Cuff Pain
Rotator cuff pain can be prevented by taking the following precautions:
- Perform regular stretching and strengthening exercises for your shoulder.
- Maintain good posture while sitting, standing or walking (avoid hunching).
- Take breaks while performing repetitive overhead activities.
- When lifting objects, keep them close to your body.
- Switch sides often when carrying a heavy bag.
- Don’t sleep on the same side every night.