The rotator cuff is a group of tendons and muscles in the shoulder that connect the humerus (upper arm) to the scapula (shoulder blade). The rotator cuff tendons provide stability to the shoulder, while the muscles allow the shoulder to rotate. Tears to the rotator cuff cause pain and affect the ability to lift the arm normally.
Rotator cuff tears are most common in people older than 40 years of age who have had shoulder problems in the past. For instance, lifting heavy objects may cause damage to the tendon. However, young people may also experience rotator cuff injuries due to long-term overuse or accidents.
Causes of Rotator Cuff Tears
- Wear and tear of the tendon tissue: The more blood supply any tissue has, the better and faster it can repair and maintain itself. The areas of poor blood supply in the rotator cuff make these tendons especially vulnerable to degeneration from aging, which can in turn lead to tendon damage and tears. Rotator cuff tears are very common in elderly people.
- Repetitive shoulder movements: As the tendon tissues degenerate, the symptoms will also become worse. The tendons of the rotator cuff can tear from long-term repeated actions. This is common in athletes who regularly use repetitive arm motions, such as baseball players. However, the damage can be caused by a wide variety of repeated daily activities, such as cleaning windows, washing cars and painting.
- Overuse of the rotator cuff: Damage and tears can also be caused by lifting objects that are too heavy, by falling, or by sustaining certain types of injury such as from being hit in the shoulder.
Symptoms of Rotator Cuff Tears
- Pain and weakness of the affected shoulder: The pain and weakness increases in line with the severity of the rotator cuff tear. When you have a small rotator cuff tear, you can often still raise your arm with mild pain. In most cases, the pain occurs only when lifting the arm. In some cases, patients can’t sleep due to the relentless pain.
- Inability to move the arm normally or lift the arm to the side: A full thickness rotator cuff tear makes it impossible to perform simple actions such as moving or lifting the arm.
Diagnosis of Rotator Cuff Tears
- Medical history and shoulder examination: Diagnosis includes a review of the patient’s medical history, including previous illnesses, accidents and pain. The doctor will then examine the shoulder. Rotator cuff tears can be easily tested. If the doctor can move your arm fully, but you can’t do it by yourself, then it is possible that you have a rotator cuff tear.
- X-ray: Although x-ray images do not show rotator cuff tears, the doctor may use an x-ray to check for bone spurs, fractures or abnormalities associated with rotator cuff tears. In addition, x-ray images can also reveal if a calcium deposit within the tendons (calcific tendonitis) is causing the symptoms.
- Magnetic Resonance Imaging (MRI): The doctor may also use an MRI scan, which uses magnetic waves to create highly detailed images of the muscles, bones and tendons in the shoulder. This technique is painless and involves no needle or injection.
Treatment Options of Rotator Cuff Tears
- Resting and using anti-inflammatory medications: Aspirin or ibuprofen may relieve the pain and inflammation. If the pain does not go away, cortisone injections may be recommended.
- Physical therapy: The doctor may consult with a physical therapist to develop a rehabilitation program for the patient. Initially, the objective is to relieve the pain and inflammation by applying hot or cold packs to the affected shoulder. Next, exercises will restore movement and strengthen the shoulder. After that, physical therapy exercises will improve the flexibility and strength of the muscles surrounding the shoulder joint. Physical therapists will help ensure that the ball of the humerus is firmly maintained in the shoulder socket, enabling the patient to move the arms normally. In most cases, patients can perform routine activities and use their arms normally after 6-8 weeks of physical therapy.
- Surgical treatments: If the patient wants to regain normal use of the arms, surgery may be required. However, surgery is not an option for patients who are elderly or at greater risks due to certain health conditions. It has been proven that the best results occur when the rotator cuff repair surgery is performed within 3 months of the initial damage. However, patients should consult with their doctor about the appropriate time for surgery. In patients with partial rotator cuff tears, surgery may not be required due to the body’s natural ability to repair damage. However, surgery may be considered in cases of relentless pain or any inability to use the arms.
- Arthroscopic debridement: In some cases, small rotator cuff tears can be treated through minimally invasive surgery. The surgeon inserts a tiny camera through a small incision in order to locate and remove dead tissue from the tendon. The camera displays pictures on a television screen. With this technique, no sutures are sewn into the tendon due to the body’s natural ability to repair small damage.
- Acromioplasty: If the rotator cuff tear is deep, arthroscopic debridement and acromioplasty may be required. With acromioplasty, the surgeon will use a burr file to file away any rough edges on the upper part of the acromion (shoulder bone). This procedure is simple and effective. However, surgery may also be needed for the surface tear.
- Arthroscopic repair: To secure torn tendons back onto the humerus, the surgeon makes small button-hole sized incisions in the area around the shoulder, removes dead tissue carefully, and stitches the tendon back onto its attachment to the humerus through the small incisions. Once the surgery is complete, the biological healing process begins.
- Suture anchor repair: With this technique, the surgeon will use special fasteners to secure the tendon back onto the humerus. During this procedure, the surgeon inserts suture anchors into the humerus. The suture is then inserted into the rotator cuff and used to pull the tendon back down on to the humerus.
- Open repair: In some situations, an open tendon repair may be considered a better option. During the procedure, the surgeon makes a large opening into the muscles of the shoulder and reattaches the damaged tendon to the bone.
Risks and Complications
There is the possibility of some complications, including damage within or close to the joint:
- Nerve injury
- Bleeding in joint, resulting in swelling and pain
- Joint infection
- Anesthesia complications
To reduce risks or complications, it is important to follow the doctor’s pre-operative and post-operative guidelines.