Topics > Shoulder > Rotator Cuff Tears
Rotator Cuff Tears
The tendons of four muscles (infraspinatus, supraspinatus, subscapularis
and teres minor) in the upper arm form the rotator cuff, blending together
to help stabilize the shoulder. Tendons attach muscles to bone and are
the mechanisms that enable muscles to move bones. It is because of the
rotator cuff tendons, which connect the long bone of the arm (the humerus)
to the scapula (the shoulder blade) that we can raise and rotate our
arms. The rotator cuff also keeps the humerus tightly in the socket (glenoid)
when the arm is raised. The tough fibers of the rotator cuff bend as
the shoulder changes position.
For normal shoulder function, each muscle
must be healthy, securely attached, coordinated, and conditioned. When
there are full or partial tears to the
rotator cuff tendons, movement of the arm up or away from the body is
impaired, making it difficult or impossible to rotate the arm in its
ball-and-socket
joint.
Shoulder pain is common among the many injuries that can happen
in the shoulder joint. Patients with rotator cuff tears in particular,
also
complain of not being able to sleep on the affected side, and muscle
weakness especially
when attempting to lift the arm. A fully ruptured tendon may make it
impossible to raise the arm or move it away from the body.
Rotator cuff
tears do not usually occur in “healthy” shoulders.
A history of shoulder problems raises the suspicion of possible rotator
tear. Risk factors for tears include repetitive overhead activities,
such as pitching a ball or painting a ceiling, excessive force with a
fall, heavy lifting, and any degeneration or abrasion of the tendons.
Diagnosis
of a rotator cuff tear is fairly easy to make on physical exam based
on the patient’s active range of motion at the joint. A
special test called an arthogram is often used to affirm a rotator
cuff tear. For this test, dye is injected into the shoulder joint before
X-rays are taken. If there is indication that dye has leaked out of
the place where it was injected into the joint, there is likely to
be a rotator cuff tear at that location. In addition, MRI and ultrasound
can be used to visualize the rotator cuff tendons.
If a tear is determined
to only be partial, conservative therapy will be initiated to control
pain and promote healing. The treatment regimen
known as R.I.C.E. can be very effective in some cases. Rest, ice, compression,
and elevation are components of this treatment. It is important to
rest the injury, as well as to initiate physical therapy as soon any
acute
pain has subsided. Anti-inflammatory medications such as non-steroid
anti-inflammatory drugs (NSAIDs) are often prescribed for pain relief.
If the recommendations of a physical therapist are followed on an ongoing
and continuous basis, many partial tears will become very manageable
with this treatment. If necessary, cortisone injections may be given
if pain continues several weeks after conservative therapy is initiated.
However, cortisone should not be used long term, as it may weaken the
tendons.
If the tear extends through the complete thickness of the tendon
there are several surgical options depending on the size, depth, and
location
of the tear. If other problems with the shoulder are discovered during
the surgery, they will be corrected as well. Surgical options include:
- Arthroscopy,
in which miniature instruments are inserted into small incisions,
can be
used
to remove bone spurs or inflammatory portions
of muscle and to repair lesser tears.
- A mini-open repair that combines
arthroscopy and a small incision can be used to treat full-thickness
tears.
- In more severe cases, open surgery is required to repair the
injured tendon. Sometimes a tissue transfer or a tendon
graft is used. Joint
replacement is also an option.
Recovering from shoulder surgery takes time, full recovery taking at
least 6 months. Success of recovery is largely based on commitment to
the exercise program your surgeon prescribes. Although each case is unique,
shoulder surgery usually results in relief of pain and restoration of
functional range of motion with compliance and hard work.
