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ROTATOR CUFF TEAR

The rotator cuff is a group of four muscles and tendons that help stabilize the shoulder. They also aid in movement. Every time you move your shoulder, you are using your rotator cuff to stabilize and help move the joint.

The rotator cuff is a commonly injured area. The most common injuries are strains, tear, tendinitis, and bursitis. The most common tear involves the supraspinatus muscle.

What are the symptoms of a rotator cuff injury?

Not all rotator cuff injuries cause pain. Some are the result of degenerative conditions, meaning the rotator cuff could be damaged for months or years before symptoms start to appear.

Common rotator cuff injury symptoms include:

  • avoiding certain activities because they cause pain
  • difficulty achieving full range of shoulder motion
  • difficulty sleeping on the affected shoulder
  • pain or tenderness when reaching overhead
  • pain in the shoulder, especially at night
  • progressive weakness of the shoulder
  • trouble reaching behind the back

Who is at risk for Rotator Cuff Injuries?

Rotator cuff injuries can be acute or degenerative.

Acute injuries usually occur from one particular incident. These can be caused by lifting objects that are too heavy, falling, or having the shoulder forced into an awkward position. Young people are more likely to experience this type of rotator cuff injury.

Degenerative injuries are due to long-term overuse. People most at risk for these injuries include:

  • athletes, particularly tennis/badminton players, baseball players, rowers, and wrestlers
  • people with jobs that require repetitive lifting, such as painters and carpenters
  • people above 40 years of age

How is a rotator cuff injury diagnosed?

Doctors use a medical history, a physical exam, and imaging scans to diagnose rotator cuff injuries. They may ask about physical activities at the workplace. These questions determine whether a patient has an increased risk for a degenerative condition.

Your doctor will also test the arm’s range of motion and strength. They will also rule out similar conditions, such as a pinched nerve or arthritis.

Imaging scans, such as an X-ray, can identify any bone spurs. These small bone growths can rub against the rotator cuff tendon and cause pain and inflammation.

Magnetic resonance imaging (MRI) or ultrasound scans can also be used. This is the gold standard for investigative tools. These tools examine soft tissues, including the tendons and muscles. They can help identify tears, as well as show how large and severe the tears had become.

Can a Rotator cuff tear heal on its own?

Even though most rotator tears cannot heal on their own, good function can often be achieved without surgery. 

Other modalities which have been used to improve the healing process is physiotherapy and ultrasound treatment. Some authors advocate this as a reasonable option and alternative prior to any surgical solution.

If, however, you are active and use your arm for overhead work or sports, then surgery is may often recommended because many tears will not heal without surgery.

How long does it take for a torn rotator cuff to heal without surgery?

Most large and full thickness tears do not heal on its own. However, the patient may adapt and come to terms with their limited function and ability over time.

On the other hand, for partial thickness tear, conservative treatment maybe a suitable option prior to a surgical solution as some authors have commended on the improved pain and functional scores 3 months after using this method.

The unconventional method of combining the regenerative techniques  along with physical therapy has shown to be and effective technique in improving the healing potential of rotator cuff tears, resulting in better outcome in patients

What happens if a torn rotator cuff goes untreated?

 If left untreated, rotator cuff tendinitis can worsen and lead to a partial tear. And a partial tear may eventually evolve into fully torn tendon. Surgery is rarely used to treat rotator cuff tendinitis unless the rotator cuff is severely damaged or torn.

What percentage of rotator cuff tears require surgery?

It is uncommon to operate on a partial rotator cuff tear. In cases of deep partial tears or when more than 90 percent of the tendon is torn, surgery maybe recommended. Surgery is only if the symptoms can’t be controlled with nonsurgical treatments.

How is a rotator cuff injury treated?

Treatments range from resting the affected arm to surgery. Tendinitis can progress to a rotator cuff tear, and that injury can get worse with time. Seeking treatment as quickly as possible helps keep the injury from progressing.

Nonsurgical treatments improve symptoms in about 50 percent of people with a rotator cuff injury. These kinds of treatments include:

  • applying hot or cold packs to the affected shoulder to reduce swelling
  • exercises to restore strength and range of motion
  • injecting the affected area with cortisone, a steroid that helps to reduce inflammation
  • resting the affected arm and wearing a sling to isolate arm motions
  • over-the-counter anti-inflammatory medications, such as ibuprofen and naproxen, as well as newer medications like Celebrex and Arcoxia

How to fix a rotator cuff tear?

Open and Arthroscopic repair are the 2 common techniques used to repair a rotator cuff tear: 

During open repair, a surgical incision is made and a large muscle (the deltoid) is gently moved out the way to do the surgery. Open repair is done for large or more complex tears. 

During arthroscopy, the arthroscope is inserted through small incision. At our center, most of the cuff tears are repaired using the arthroscopic means.

 The three most common surgery types to treat rotator cuff tears are:

  1. Open repair surgery, which requires a 4 to 6 cm incision.
  2. Arthroscopic repair, surgery involving one or more incisions of less than 1 cm. This method allow for faster mobilization and recovery.
  3. Mini-open repair, which is a combination of open and arthroscopic surgery, and includes an incision of 1 to 5 inches, depending on the repair. This technique may be used when a patient has more than one tendon tear.1

What happens during rotator cuff surgery?

 Surgery typically involves:​

Making space for the rotator cuff tendons to move​

  • The surgeon removes loose fragments in the rotator cuff area, such as bone spurs, pieces of tendon, or inflamed sections of the bursa sac. This procedure is called shoulder debridement.​
  • The surgeon might also shave down the acromion bone that located at the top of the shoulder, which can pinch the rotator cuff. This procedure is called shoulder decompression.

Stitching together the torn edges of the damaged rotator cuff and re-attaching it to the humerus bone.

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