The human shoulder allows for all types of movement. However, this can also increase the risk of injury to the joint. To perform activities like serving a tennis ball, combing hair, or reaching for something on the top shelf, we need to coordinate the muscles that stabilize and move the shoulder blades and humerus. 

These injuries to muscles and tendons can interfere, with daily activities making them difficult and painful. There are many causes of shoulder pain, the symptoms, diagnosis, and treatment of a rotator cuff tear are discussed below. Rotator cuff tears are rare before the age of 40, but they occur more frequently with age. It is important to note that not all RCTs cause symptoms. However, if you experience unresolved shoulder pain or injury, it’s essential to see a doctor.

Here are Rotator Cuff Tears: Top 10 Frequently Asked Questions provided by Dr Chandra Shekar. B. Before that, let us see!

What is a Rotator cuff and a rotator cuff tear?

A rotator cuff is a group of four tendons that mix to stabilize and move the shoulder. Each of the four tendons connects the muscles starting from the scapula to the upper arm bone (humerus). The musculoskeletal components of the rotator cuff are:

• Supraspinatus, which extends across the top of the ball from the shoulder joint (head of the shoulder);
• Subscapularis, which pass through the front of the head and shoulders
• Infraspinatus and Teres minor, which flow through the back of the humeral head.

The rotator cuff tear resulted from a combination of tendon injury and weakened wear and tear damage, disuse, repeated use of steroid injections (cortisone), and smoking.

The degree of injury required to tear the cuff depends on the quality of the tendon. The tendon of the young, healthy rotator cuff is almost impossible to tear. However, an older tendon, repeatedly injured, repeatedly injected, or a tendon from a smoker, can tear without injury. Tears in younger people tend to spread only partially into the tendons (partially thick tears). Tears in the elderly are more likely to tear a complete tendon (complete thickness tear) and affect multiple tendons.

The rotator cuff muscle and tendon may also tear partially or entirely. A worn or partially worn tendon is classified as a partly thick tear. In contrast, a tear of full-thickness ranges from a hole right in the muscles and tendons of the rotator cuff to significant tissue damage. This type of rupture can affect one or more tendons and completely separate the rotator cuff tendon from the humeral head in the most severe cases.

Where does the rotator cuff tear, and how do you know it?

As your shoulder moves, the rotator cuff keeps the head of the shoulder pressed into the glenoid socket. If the humeral head does not remain in the glenoid fossa, it rises and hits under the acromion, outside the scapula, causing a blow. Impingement g causes bursitis (inflammation of bursitis) and tendinitis (inflammation of the tendons). This ultimately results in a partial full-thickness rotator cuff tear . Clinically, sufferers will experience pain and weakness.

Athletes who participate in sports that require a lot of overhead activity are at increased risk of having a rotator cuff rupture. Traumatic events – such as a sudden fall on the shoulder or a collision with an object or player can cause tears. Tears are also caused due to repeated movements throwing a ball.

One way to know if you have a tear is to do the following tests:

Keep your elbow straight and try to elevate your arm above your head.. if you experience pain and weakness while doing it, you might be having a rotator cuff injury.

If you  need to make an appointment for a consultation with Dr Chandra Shekar. B. 

What are the most common causes and types of rotator cuff injuries?

Tendonitis, bursitis, and tears are the three most common types of rotator cuff injuries.

Rotator cuff tendonitis also called shoulder impingement syndrome, which occurs when the tendon connecting the rotator cuff muscle to the humerus is irritated or inflamed. Likewise, bursitis occurs when the bursae or fluid-filled pads that act as pillows in the joints become painful and swollen. This can be due to  several reasons, including:

• Repetitive overhead movement
• Keep your hands in the same position for a long time
• Long-term compression of the arm
• Sudden injury
• Osteoarthritis

How does it feel to have the rotator cuff torn?

Common symptoms are:

• Vague pain in front of your shoulder
• Pain radiating down the side of your arm
• Recurrent pain with overhead activity
• Nocturnal pain that wakes you from sleep
• Weakness (especially when trying to raise the arm)
• Loss of freedom of movement
• It’s hard to raise your hand away from you
• The sensation of catching or clicking when you move your hand

When should I see a doctor about a torn cuff?

If you injured your shoulder or have chronic shoulder and arm pain, it’s best to contact your orthopaedic surgeon. They can then diagnose and begin treatment. Your doctor may recommend diagnostic imaging tests. Early diagnosis and treatment of a rotator cuff tear can prevent symptoms such as loss of strength and mobility.

If your doctor has made a diagnosis, your shoulder surgeon can review surgical and non-surgical options and begin treatment.

How is a rotator cuff tear diagnosed?

Shoulder pain is common and can be caused by problems other than the rotator cuff rupture. After receiving a medical history and physical examination, your doctor will decide whether imaging is needed to determine the injury’s type and severity. Magnetic resonance imaging (MRI) and ultrasound imaging are the primary imaging tools used to diagnose and characterize RCTs. 

Both have the same sensitivity in finding and describing RCTs. An MRI can show very detailed images of your entire shoulder joint, with ultrasound providing a live, real-time visualization of the muscles and tendons as they move. However, if shoulder instability is a problem, contrast-enhanced MRI is a more appropriate test. X-rays are often taken to see if arthritis or bone spurs  are contributing to the pain. X-rays, while helpful, cannot diagnose RCTs.

 What is the Average Recovery Time for a rotator cuff injury?

In most cases, recovery can take 4 to 6 months or more, depending on the crack’s size. Patients can resume most of the activities after six months, but the rotator cuff will heal within a year.

Can a rotator cuff tear be cured without surgery?

Many rotator cuff tears cannot be treated with surgery. Anti-inflammatory drugs, steroid injections, and physical therapy can all help treat symptoms of a cuff rupture. The goal of treatment is to relieve pain and strengthen the affected shoulder.

Although most tears do not heal on their own, good function can often be achieved without surgery.

However, if you are active and use your hands to do overhead work or sports, surgery is most often recommended because many tears will not heal without surgery.

When should I have surgery?

For partial and chronic RCTs, a 6-12 week non-surgical treatment study, as described above, is appropriate. If symptoms or weakness are acutely worsening, a reassessment should be carried out to determine the tear’s severity and nature. Early surgical referral should be considered if there is an acute tear of the total thickness or a large chronic tear.

When does the rotator cuff need to be operated to fix it?

If you have persistent pain or weakness in your shoulder that doesn’t improve with non-surgical treatment, surgery is recommended. Often, patients who need surgery report pain at night and difficulty lifting and grabbing the arm. Many report persistent symptoms despite months of treatment and limited hand use.

Surgery is also indicated for active individuals who use their hands to work on the head or exercise. Swimmers and tennis players are common examples.

How are major surgical injuries to the rotator cuff tendon repaired?

An arthroscope is very useful in repairing the rotator cuff tendon. Using an arthroscope in early fall allows visualization of the inside of the joint to facilitate cutting and removal of torn cuff tendon fragments and bicep tendons. In the next step, the spurs and ligaments that thicken under the acromial bone are made visible with the current arthroscope and are removed with miniature cutting and shaving tools. 

If it is necessary to sew a break in the rotator cuff that has pulled the bone,  to reattach the tendon, doctors make strong suture to the rotator cuff tendons to the bone. 

How successful is rotator cuff surgery?

Here, too, each case is unique. In a young, healthy person with a light tear of the rotator cuff, the operation can predictably succeed. if the injury becomes more severe, e.g. With large bone and tendon tear, cannot expect perfect results. Because an unhealthy tendon has to be cut before reconnecting to the bone, there is often limited motion in the shoulder.

 However, pain relief and increased strength are usually comparable to slightly limited mobility. The result often depends on the individual’s willingness and ability to undertake a postoperative physical therapy program.

What happens if the rotator cuff is not repaired?

 If the tendon edges are severely fragmented and worn, and the muscles contract and atrophy, recovery may not be possible at this time. Neglected rotator cuff tears lead to arthritis called rotator cuff arthropathy.

 Sometimes the only surgical procedure useful in neglected rotator cuff tears  is arthroscopic surgery to remove bone spurs and torn tissue fragments that become entwined when the arm is rotated. This, of course, doesn’t restore normal strength or strength to the shoulder, but it often eases pain.

Does physiotherapy help?

Physical therapy is the first step in treatment for most RCTs. However, if a large RCT or a sudden injury is causing severe shoulder weakness, early surgical repair may be indicated. Physical therapy is gradual, with first increased freedom of movement and increased function through strength and coordination of the shoulders’ muscles. Physiotherapy may be more useful for people under the age of 60 and people with partial-thickness cracks.

Conclusion:

Although large rotator cuff tears are rare, a combination of conservative treatment and surgery is beneficial. If left untreated, large tears can lead to arthritis. In particular, the variety of rotator cuff rupture and arthritis is known as rotator cuff arthropathy. Unfortunately, options are limited for this condition. In most cases, shoulder replacement is necessary to restore strength, mobility, and function to the shoulder. Patients should see an orthopaedic surgeon immediately after injury to avoid arthropathy and associated complications.

Hyderabad Shoulder clinic offers a variety of blogs related to rotator cuff tears. If you are worried about your cuff tear and are experiencing any of the symptoms listed in this article, or have difficulty moving your arm, make an appointment with Dr Chandra Shekar. B by contacting us at   91 9959588389