Rotator Cuff Tear

By: Amelia McCaffrey

Introduction

The shoulder joint has important functions in our day to day lives. I know people who have had shoulder injuries and shoulder pain and I was curious to learn more about the joint itself and also what causes tearing of the shoulder muscle.

Anatomy

The shoulder is made up of three bones: the humerus, scapula, and clavicle. The shoulder is a ball-and-socket joint. The arm is kept in the shoulder by the rotator cuff. The rotator cuff consists of four muscles: supasipinatus, infaspinatus, teres mino, subcapularis. These muscles come together as tendons to form a covering around the head of the humerus and also attaches the humerus to the shoulder blade. This helps to lift and rotate the arm.


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.


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Mechanism of Injury

The tendons in the shoulder become injured in the event of aggressive shoulder joint movement. Depending on the degree of the injury to the shoulder joint the injury may be tendonitis or a tear. A partial tear damages soft tissue, but does not completely sever. In a full- thickness tear the soft tissue splits into multiple pieces.


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 at rest and at night, if lying on affected shoulder

- 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.


Imaging Tests:

- 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.

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Management

Nonsurgical Treatment: relieves pain and improves function

- Rest

- 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.

Rehabilitation:

- Immobilization: Repair needs to be protected in order to heal properly. Use sling and avoid using arm for 4-6 weeks.

- 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.

Prevention

- If possible avoid excessive overhead exercises

- Strengthen shoulders and don't try to play or work through the pain

Conclusion:

Rotator cuff tear is a painful injury to the tendons in the shoulder. It's important to prevent this injury by avoiding excessive overhead movements, strengthening shoulder muscles, and listen to your body to prevent further damage if there is a tear. Get early treatment for better results and for faster healing time.

Resources:

"Show Menu." Rotator Cuff Tears. N.p., n.d. Web. 02 June 2015.

"Rotator Cuff Tears-OrthoInfo - AAOS." Rotator Cuff Tears-OrthoInfo - AAOS. N.p., n.d. Web. 02 June 2015.