Rotator Cuff is a group of four muscles – supraspinatus, subscapularis, infraspinatus, and teres minor. These muscles together with their tendons surround the shoulder joint and hold the arm in place, allowing the shoulder to move in different directions, and keeping it stable. A Rotator Cuff Injury refers to irritation or damage to any of these rotator cuff muscles and tendons. Tears mostly occur in the supraspinatus tendon, as it passes just below the Acromion, the bony process on the shoulder-blade. People who repeatedly perform overhead motions in their jobs or sports, such as, baseball players, tennis players, carpenters, painters, swimmers, and football players, are more vulnerable towards such Tears. The risk of developing Rotator Cuff Tears may also enhance with age.
Types of Rotator Cuff Tears
There are three types of Rotator Cuff Tears:
- Partial Thickness Tears which appear as fraying of an intact tendon but do not detach from the attachment site.
- Full Thickness Tears which may appear as small or large holes and involve majority of the tendon staying substantially attached to the bones.
- Full Thickness Tears may also completely detach from the bone resulting in an impaired shoulder motion and reduced function.
One may experience Rotator Cuff Tears for the following reasons:
- Falling on arm/shoulder
- Using arm to break a fall
- Lifting heavy objects or lifting them improperly
- Repetitive overhead movement of arms
- Bone Spurs or overgrowth of bones
- Degenerative tear
Signs and Symptoms
The key symptoms of Rotator Cuff Tears are as follows:
- Pain in the shoulder and arm
- Night pain, particularly when lying on the affected shoulder
- Weakness while lifting or rotating the arm
- Tenderness in the arm
- Snapping or crackling sensation while moving the shoulder
- Difficulty in moving the shoulder, particularly while lifting the arm overhead
The subject-matter expert for Rotator Cuff Tears is an Orthopedic.
The doctor will carry out the following steps to diagnose a Rotator Cuff Tear:
History: The specialist will make a note of the patient’s medical history, overall health condition, symptoms, and severity of pain.
Physical Examination: During a physical examination, the doctor will check for tenderness or deformity. The specialist will also test the arm strength and check for other issues with shoulder joint. He may move the arm in different directions to measure the range of motion of the affected shoulder.
Laboratory Tests: Imaging Tests such as, X-Rays, MRI, and Ultrasounds show information on bones and soft tissues. X-Rays may show details about Bone Spurs only.
Treatment Modalities Available for Management of the Disorder
Self-care measures, drugs, and therapy help in recovery of Rotator Cuff Tears. The non-surgical treatment options include:
- Resting the joint and avoiding activities that provoke pain
- Icing the shoulder two-three times a day to reduce swelling and pain
- Perform range of motion exercises
- Physical therapy to help restore flexibility and strength to the shoulder
- Anti-inflammatory pain killers and Steroid injections for relieving pain
Serious Rotator Cuff Tears may require Arthroscopy for repairing the Rotator Cuff Tear. If the tear is large or involves more than one tendon, the surgeon may make a small incision. Other surgical options include Bone Spur Removal and Tendon Replacement. Massive Rotator Cuff Injuries coupled with Arthritis may require a Shoulder Replacement Surgery.
Providing adequate rest to the shoulder is imperative for recovery of Rotator Cuff Tears. However, total immobilization may lead to Frozen Shoulder indicating thickening and tightening of the connective tissues.
Patients suffering from Rotator Cuff Tears should undertake the following precautions:
- Avoid further injury as it may aggravate the condition.
- Provide rest to the joints as much as possible.
- Avoid or modify activities that cause shoulder pain.
Dietary and Physical Activity Requirements
Resting the shoulder joints is extremely essential in Rotator Cuff Tears. Patients should avoid arm movements that cause stress and abuse on the Rotator Cuff Tear. However, they should strictly follow and perform exercises as suggested by the therapist to strengthen the muscles supporting the shoulder.
Prevention of the Disorder from Happening or Recurring
To prevent Rotator Cuff Tears from occurrence or recurrence, one should daily perform shoulder stretches and exercises. It is essential to strengthen muscles at the back of the shoulder and around the shoulder-blade to maintain shoulder muscle balance. With the help of a specialist or therapist one should work out an exercise regimen and carry out the required exercises using proper techniques.
Support and Help given by the Caregiver
Rotator Cuff Tears can create enormous problems for carrying out simple activities. Under such conditions, caregivers should assist the patient in coping with pain and help them in performing their daily tasks.