What is the rotator cuff and what does it do?
The
rotator cuff is a group of four muscles that
surround the shoulder joint, keeping the head of your upper arm bone firmly
within the shallow socket of the shoulder. Thus, the rotator cuff stabilize the ball of the
shoulder within the joint and there by helps to lift and rotate the arm.
What Is a Rotator Cuff Tear?
A rotator cuff tear is a rip in the Rotator
Cuff muscle tendon complex.
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.
What are the Causes and Risk Factors?
A rotator cuff tear :-
1) May
result from an acute injury, such as a fall
2) May
be caused by wear and tear with degeneration of the tendon.
A rotator cuff tear resulting from injury can
happen to anyone but the risk of a degenerative tear goes up with:
- Occupation. Jobs like house
painters and construction workers put you at a higher chance of rotator
cuff tears.
- Lack of blood supply. As you
get older, you get less blood to your rotator cuff area, which makes small
tears hard to repair, leading to larger tears.
- Bone spurs. Bone
overgrowth in the shoulder, which happens more often as you get older, can
wear away the rotator cuff tissues and cause tears.
- Age. Rotator cuff tears
are most common in people over 60.
- Athletics. Baseball, tennis,
rowing, and weightlifting are sports that stress your rotator cuff and put
you at risk of tears.
how would I know if I have a rotator cuff tear?
If the tear occurs
with injury, you may experience acute pain, a snapping sensation, and immediate
weakness of the arm.
With degenerative
tears, typically, you will feel pain in the front of your shoulder that
radiates down the side of your arm. It may be present with overhead activities
such as lifting or reaching. You may feel pain when you try to sleep on the
affected side. You may note weakness of your arm and difficulty with routine
activities such as combing your hair or reaching behind your back.
The pain associated with a rotator cuff injury may:
· Be described as a dull ache deep in the shoulder
· Disturb sleep
· Make it difficult to comb your hair or reach behind your back
· Be accompanied by arm weakness
Pain may-not be there in some cases of rotator cuff tears.
But in some cases, you might:
- Have
trouble raising your arm
- Feel
pain when you move your arm in certain ways or lie on it
- Have weakness
in your shoulder
- Be
unable to lift things like you normally do
- Hear
clicking or popping when you move your arm
If
I have a painful rotator cuff and keep using it, what will happen?
If you don’t do anything about a
torn rotator cuff, you can have more serious problems over time.
A rotator cuff
tear can extend or get larger over time. This can occur with repetitive use or
a re-injury. It is common for patients with known rotator cuff disease to have
acute pain and weakness following a minor injury. This likely represents
extension of an existing tear.
Without
treatment, rotator cuff problems may lead to permanent loss of motion or
weakness, and may result in progressive degeneration of the shoulder joint
called arthritis. Although resting your shoulder is necessary for your
recovery, keeping your shoulder immobilized for a prolonged time can cause the
connective tissue enclosing the joint to become thickened and tight (frozen
shoulder).
both frozen shoulder and
arthritis are harder to treat and the treatment results may not be very
good.
How is
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 physical exam, your doctor will press on
different parts of your shoulder and move your arm into different positions. He
or she will also test the strength of the muscles around your shoulder and in
your arms.
In addition, your doctor may use one of the following:
• X-rays
to see if the top of your arm bone (humeral head) is pushing into your rotator
cuff space.
• MRI,
which uses radio waves and a powerful magnet to make detailed pictures of your
shoulder.
• Ultrasound
to see the soft tissues (tendons, muscles, and the bursas) in your shoulder.
Can
a rotator cuff tear be healed without surgery?
Many
rotator cuff tears can be treated without surgery. Anti-inflammatory
medication, shoulder joint injections, physical therapy and exercises may all
be of benefit in treating symptoms of a cuff tear. The goals of treatment are
to relieve pain and restore strength to the involved shoulder. Even though most
tears cannot heal on their own, good function and pain relief can often be
achieved without surgery.
If, however, you
are active and use your arm for overhead work or sports, then surgery is most
often recommended because many tears will not heal without surgery.
At
what point does a rotator cuff tear require surgery to fix it?
Surgery
is recommended if you have persistent pain or weakness in your shoulder that
does not improve with nonsurgical treatment. Frequently, patients who require
surgery will report pain at night and difficulty using the arm for lifting and
reaching. Many will report ongoing symptoms despite several months of
medication and limited use of the arm.
Surgery is also
indicated in active individuals who use the arm for overhead work or sports.
Pitchers, swimmers, and tennis players are common examples.
What
options are available for surgical repair?
It’s likely your doctor will reattach the tendon to the
bone. In some cases, they might need to take out small pieces 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:
1)
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 wound will be smaller than it would with another type of
surgery.
2)
Open: Your doctor uses a larger skin cut to go into the muscles of your
shoulder and fix the tear.
3)
Mini-Open: This uses a skin cut smaller than open procedure and larger than
that would be with arthroscopic surgery. This combines the principles of both arthroscopic
and open surgery. In fact, your doctor may start with the arthroscope for the
initial steps and finishes with larger instruments.
Sometimes it may
not be possible to reattach your torn tendon. In such situations other
surgeries are to be done to regain the function of your shoulder and for relief
of symptoms. These can be: -
1)
Tendon transfer: If your rotator cuff tendon is too torn to reattach, the
doctors can use another nearby muscle tendon.
2)
Shoulder replacement: If the rotator cuff tear is large enough, you may need to
have your shoulder joint replaced.
Your orthopedic surgeon can recommend which technique is best for you.
How
important is rehabilitation in the treatment of a rotator cuff tear?
Both in the nonsurgical
and surgical treatment of a rotator cuff tear rehabilitation plays a critical
role.
Even though surgery repairs the defect
in the tendon, the muscles around the arm remain weak, and a strong effort at
rehabilitation is necessary for the procedure to succeed.
Also not moving your shoulder (with or
without surgery) can lead to stiffness of shoulder called frozen shoulder
mentioned above. Not doing rehabilitation properly can take away all the
benefits of doing surgery and the end result can be even worse.
Complete rehabilitation after surgery
may take several months.
Your orthopedic surgeon can prescribe
an appropriate program based on your needs and the findings at surgery.
When will you be able to
use your hand normally after surgery?
It varies from patient to patient, and also depends on the findings during surgery. In most cases it can take few months before you can use your hand normally.
