The rotator cuff is a network of four muscles and several tendons that form a covering around the top of the upper arm bone. It functions to hold the humerus in place within the shoulder joint and enables the arm to rotate.
Of the four muscles, one muscle – the supraspinatus muscle, is affected the most by tears which causes pain and significant disability among adults. In a partial tear, only an area of the tendon is damaged. In this type of injury, the tear does not go all the way through the tendon.
The incidence of rotator cuff damage increases with age and is most likely due to weakness and wear of the muscle. The correct incidence of partial rotator cuff tears is difficult to determine because 5% to 40% of people without any symptoms may actually have a torn rotator cuff.
A rotator cuff tear can be a result of a single traumatic injury. A cuff tear may also occur if there is a fracture dislocation of the shoulder.
Most tears, however, are the result of overuse of these muscles and tendons over a long period of time. People who are especially at risk for overuse are those who engage in repetitive overhead motions like baseball, tennis, weight lifting, and rowing.
Rotator cuff tears are most commonly found in people who are middle aged and older, particularly as a result of wear and tear. Younger people also may suffer from a rotator cuff tendon tear after an acute trauma incedent or repetitive overhead motions. Rotator cuff tears are common in older patients because their blood supply diminishes with age. Diminished blood supply contributes to tendon degeneration. The body’s ability to repair the damage caused to the tendon decreases with age and this can ultimately lead to a complete tear of the rotator cuff.
Pain is often the first symptom of this injury, and generally develops right after the trauma. Some patients report having pain for several months. Pain is felt when lifting the arm and lowering the arm from a fully raised position. There is weakness as you lift and rotate the arm. You may also hear a crackling sound when you move the shoulder in certain positions.
Symptoms may also develop gradually with repetitive overhead activity or following long-term wear. Pain in the front of the shoulder can radiate down the side of the arm. At first, the pain may be mild and occur only after an activity. Over time, you may have pain even while you are resting and at night when you are sleeping.
Due to limited use of your from this injury, you may develop frozen shoulder.
The diagnosis of a rotator cuff tear is generally based on the symptoms and physical examination. Your doctor will ask you specific questions about your pain and its occurrence. He will examine the shoulder to see whether it is tender in any area or whether there is any deformity felt when palpating the area of pain. He will ask you to rotate your arm and will measure the range of motion of the shoulder in several different directions and will test the strength of the arm. X-rays, and imaging studies, such as MRI (magnetic resonance imaging) or ultrasound, are also helpful.
Your doctor may also examine your neck to make sure that the pain is not the result of a “pinched nerve ” in the neck or spine and also to rule out other conditions, such as osteoarthritis or rheumatoid arthritis.
X-rays are generally not helpful, but an MRI can better visualize soft tissue structures such as the rotator cuff tendons. Getting an MRI may be able to show how large the tear is as well as its location within the tendon itself or where the tendon attaches to bone.
Treatment can be either conservative, medical,or surgical, but the decision on how to treat it is based on a patient’s severity of symptoms, functional requirements, and presence of other illnesses that may complicate a given treatment.
Give plenty of rest to your arm by limiting overhead activity. Apply ice on the painful area for fifteen minutes 2-3 times a day. Seek help to learn physical therapy to treat this injury from a physiotherapist. He may also teach you some strengthening exercises.
Anti inflammatory medications can help in reducing pain. Your doctor may also give you a steroid injection to relieve pain.
Surgery is recommended if nonsurgical treatment fails to relieve symptoms or the tear is very painful. If less than 50% of the tendon is torn, then the tear usually does not require repair.
The type of surgery performed depends on the size, shape, and location of the tear on the tendon.
Read more about using PRP for Partial Rotator Cuff Tear.
Prognosis is generally good if treatment is initiated early.
Rotator cuff exercises to strengthen the rotator cuff helps to stabilize the shoulder joint and reduce the risk of rotator cuff injuries. Avoiding lifting anything heavy. If you have to lift a heavy item, try using both of your hands to lift the item to distribute the weight evenly. Also take breaks after prolonged activities. Maintaining proper posture can also help in preventing rotator cuff tears.