Rotator Cuff Tear
By: Amelia McCaffrey
Between the rotator cuff and the bone on the top of the shoulder, there's a lubricating sac called a bursa. This allows the tendons to glide freely when the arm moves.
Mechanism of Injury
In an Acute Tear, is if you fall down on your outstretched arm or lift something that's too heavy. This type of tear can also occur with a broken collarbone or dislocated shoulder.
With a Degenerative Tear, this is the result of wearing down of the tendon that occurs slowly over time. They are most common in the dominant arm, but if you have a degenerative tear in one shoulder, there is a greater risk for a tear in the opposite shoulder. Several factors contribute to a degenerative or chronic rotator cuff tears.
- Repetitive stress: Repeating the same shoulder motions can stress rotator cuff muscles and tendons. Baseball, tennis, swimming, rowing are some examples that put you at risk for overuse tears.
- Lack of Blood Supply: Blood supply to our rotator cuff tendons lessen as we age.
- Bone Spurs: Bone overgrowth often develop as we age on the underside of the acromion bone.
Signs and Symptoms:
- Pain when lifting and lowering arm or with specific movements
- Weakness when lifting or rotating arm
- Crepitus or cracking when moving your shoulder in certain positions
Tears that happen suddenly, such from a fall, usually cause intense pain. May be a snapping sensation and immediate weakness in upper arm.
Overuse tears also cause pain and weakness. Pain when lift shoulder to the side, or pain that moves down the arm. Pain may be mild at first, but overtime will be noticed at rest and over-the-counter medications don't work. Routine activities will become more difficult.
- X-rays: First imaging test done. Since doesn't show soft tissue, plain x-rays of the shoulder with rotator cuff pain are usually normal or may show small bone spur.
- MRI or Ultrasound: These studies show soft tissue better and if there is a rotator cuff tear and where it's located. MRI can also indicate how "old" or "new" the tear is by showing quality of muscles.
- Activity Modification
- Non-steroidal anti-inflammatory medication
- Strengthening and Physical Therapy
- Steroid Injection
Surgical Treatment: may need surgery if pain doesn't improve with nonsurgical methods.
Pain has lasted 6-12 months, large tear (more than 3cm), significant weakness and loss of function in shoulder, acute injury.
- Passive Exercise: Muscles remain weak even though tear is repaired. With passive exercises therapist holds arm while moving it in different positions. Usually, begin within the first 4-6 weeks after surgery.
- Active Exercise: Perform exercises without help by therapist. Gradually increase strength and improve arm range of motion. At 8-12 weeks therapist will start on a strengthening exercise program.
Most patients have functional range of motion and adequate strength by 4-6 months after surgery.
- Strengthen shoulders and don't try to play or work through the pain
"Rotator Cuff Tears-OrthoInfo - AAOS." Rotator Cuff Tears-OrthoInfo - AAOS. N.p., n.d. Web. 02 June 2015.