Rotator Cuff Tears
A rotator cuff tear is a common cause of pain and disability among adults. A torn rotator cuff weakens the shoulder and makes daily activities painful and difficult to do.
The rotator cuff consists of muscles and tendons that hold the shoulder in place. The rotator cuff is a group of four muscles that are positioned around the shoulder joint. They help to stabilize the shoulder joint and also help with shoulder joint movement. The rotator cuff allows a person to lift his or her arms and reach up. Injury to Rotator Cuff tissue is commonly referred to as a: rotator cuff tear. When one or more of the rotator cuff tendons is torn, the tendon no longer fully attaches to the head of the humerus. In many cases, torn tendons begin by fraying. As the damage progresses, the tendon can completely tear.
There are different types of tears.
- Partial Tear: This type of tear damages the soft tissue, but it does not completely detach from its insertion on the humeral attachment.
- Full-Thickness Tear: This type of tear is also called a complete tear. With most rotator cuff tears the tendon tears off of where it attaches to the head of the humerus.
There are two main causes.
- Acute Tear: Common mechanisms of injury include a seatbelt/shoulder harness injury a fall on an outstretched arm, or lifting something too heavy. This can occur in conjunction with other shoulder injuries such as a broken collarbone or dislocated shoulder.
- Degenerative Tear: This is the most common cause. It occurs slowly over time and is most common in the dominant arm. If you have a degenerative tear in one shoulder, there is a greater risk for a tear in the opposite shoulder, even if you have no pain in that shoulder.
Non-Surgical Treatment Options Include:
- Rest and the possible use of a sling to immobilize the shoulder
- Activity modification
- Strengthening exercises and physical therapy
- Anti-inflammatory medications and possible Steroid injections
- Some patient opt for regenerative options including the introduction of stem cells to the shoulder to encourage healing of the damaged tissue.
Rotator cuff tear symptoms
- Pain while resting and at night, particularly if lying on the affected shoulder
- Pain when lifting and lowering your arm
- Weakness when lifting or rotating your arm
- Grinding and crunching sensation when moving your shoulder in a certain position
- Tears that happen suddenly will cause intense pain and there may be a snapping sensation, followed by immediate weakness in your upper arm
- There may be stiffness, swelling, loss of movements, and tenderness in the front of the shoulder.
If you have torn your rotator cuff and you keep using it despite pain, you may cause further damage and a larger tear. Early treatment can prevent your symptoms from getting worse and will get you back in a normal routine much quicker.
There are several treatment options and the best option depends on the patient. Your physician will consider your age, activity level, general health and type of tear you have before deciding on the best treatment plan for you.
Nonsurgical Treatment: Many rotator cuff tears respond well to conservative therapy. Nonsurgical treatment relieves pain and improves function in the shoulder; however, shoulder strength does not usually improve without surgery.
Surgical treatment for rotator cuff tears
Surgery is necessary if your pain does not improve with nonsurgical methods. Continued pain is the main indication for surgery. If you are active and use your arms for overhead work or sports, your physician may suggest surgery.
Surgery to repair a torn rotator cuff involves re-attaching the tendon to the head of the humerus at the greater tuberosity. There are a few options for repairing tears of the rotator cuff and your orthopedic surgeon will discuss the best procedure for your type of tear.
Rotator cuff repair may be performed by open surgery or arthroscopic procedure. Most rotator cuff repairs are now fixed arthroscopically (using a camera and instruments through small incisions). Surgery to repair a torn rotator cuff most often involves re-attaching the tendon to the head of humerus (upper arm bone). Anchors, with high strength sutures in them, are placed into the bone along the attachment site of the torn rotator cuff. The sutures are then passed through the torn rotator cuff tendon and secured back to the bone. A partial tear, however, may need only a trimming or smoothing procedure called a debridement. Any impinging bone spurs are also taken down during the procedure using a high speed burr.
Our orthopedic surgeons use the latest in surgical and non-surgical techniques to care for the full range of athletic, degenerative, and traumatic shoulder disorders.