Rotator Cuff Tears
What is the rotator cuff?
The rotator cuff is made of the supraspinatus, infraspinatus, subscapularis and teres minor muscles and their tendons. The “cuff” acts as a cover around the top of the humerus (upper arm bone). The rotator cuff holds the humerus in place in the shoulder joint, allowing for lifting and rotation of the arm. Rotator cuff tears occur most frequently in adults over the age of 40, but are also seen in younger individuals following acute trauma, during sports or with repetitive overhead work.
What causes the rotator cuff to tear?
Rotator cuff tears can be the result of:
- Overuse of the muscles and tendons over a period of years
- Participating in sports requiring repetitive overhead motion (baseball, tennis, wt lifting, rowing)
- A single traumatic injury
Symptoms:
When the tear is a result of a traumatic event, the most common symptoms are:
- Sudden, acute pain
- Snapping sensation
- Immediate weakness in the arm
- Pain when lifting the arm
- Pain when lowering the arm from a fully raised position
When the tear occurs as a result of overuse over a period of time, common symptoms are:
- Pain in front of the shoulder that may radiate down the side of the arm
- Pain when lifting the arm
- Pain when lowering the arm from a fully raised position
- Pain may become noticeable even with no activity
Diagnosis:
Your physician will take a detailed history and will conduct a thorough examination which will include assessing the range of motion of your shoulder and arm strength. An x-ray will show any evidence of osteoarthritis or the presence of a bone spur. If a rotator cuff tear is suspected, your physician will generally order an MRI at the Imaging Center to visualize the soft tissue structures and tendons.
Treatment Options:
Your physician will discuss both non-surgical and surgical treatment options with you. The recommended treatment will be based on many factors, including your age, response to previous treatment, the size of the tear, the activities you wish to go back to and how the tear occurred.
Non-surgical treatment can successfully provide pain relief and improve the function of the shoulder.
These options may include:
- Non-steroidal, anti-inflammatory medication
- Steroid injection
- Rest and limitation of overhead activities
- Instruction in strengthening exercises
- Physical therapy
Surgical treatment may be recommended if the tear has just resulted due to trauma, if non-surgical treatment options have not relieved the symptoms, if the tear is in the dominant arm of an active individual or if restoration of maximum strength is required for work or activities.
The type of surgical procedure depends on:
- Size of the tear
- Shape of the tear
- Location of the tear
Your physician will discuss with you the surgical procedure he intends to perform. Most surgical repairs are done on an out-patient basis. The three most common surgical approaches are:
- Arthroscopic repair
- Mini-open repair
- Open repair
Rehabilitation following surgery:
Following surgery, your arm will be immobilized in a sling to allow the tear to heal. Your physician will instruct you in passive range of motion exercises and will determine the length of the immobilization. S/he will then refer you to physical therapy, which will incorporate active and resistance exercises to allow you to regain motion and strength in the shoulder. In order to maximize a positive outcome from surgery, a strong commitment to rehab is essential. Your physician and your therapist will work together to monitor your progress and determine when you can return to overhead work and participation in sports.
