What is a Rotator Cuff Tears?
The rotator cuff is a large tendon comprised of four muscles which combine to form a "cuff" over the upper end of the arm, the head of the humerus. The four muscles—supraspinatus, infraspinatus, subscapularis and teres minor—originate from the "wing bone," the scapula, and together form a single tendon unit that inserts on the greater tuberosity of the humerus.
What are the causes?
Injuries and degeneration. Several factors contribute to degenerative:
- Repetitive stress.
- Lack of blood supply
- Bone spurs
Who can be affected?
- People who do repetitive lifting or overhead activities.
What are the symptoms?
- Pain when lifting and lowering your arm
- Crepitus or crackling sensation
How is’t diagnostic?
- Magnetic resonance imaging (MRI)
How can be treated?
- Activity modification
- Non-steroidal anti-inflammatory medication
- Strengthening exercises and physical therapy
Surgery is recommended if you have persistent pain or weakness in your shoulder that does not improve with nonsurgical treatment. Surgery is also indicated in active individuals who use the arm for overhead work or sports. Pitchers, swimmers, and tennis players are common examples
Rotator Cuff Tears
The rotator cuff covers the head of the humerus and stabilizes the shoulder joint.
AnatomyThe rotator cuff helps to lift and rotate the arm and to stabilize the ball of the shoulder within the joint. The rotator cuff is made up of four muscles and their tendons. These combine to form a " cuff " over the upper end of the arm (head of the humerus).The four muscles of the cuff (supraspinatus, infraspinatus, subscapularis, and teres minor muscles) are attached to the scapula on the back through a single tendon unit. The unit is attached on the side and front of the shoulder on the greater tuberosity of the humerus.
A tear can occur within the muscle.
SymptomsSome of the signs of a rotator cuff tear include:
DiagnosisDiagnosis of a rotator cuff tear is based on the symptoms and physical examination. X-rays, and imaging studies, such as MRI (magnetic resonance imaging) or ultrasound, are also helpful.Your doctor will examine the shoulder to see whether it is tender in any area or whether there is a deformity. He or she will measure the range of motion of the shoulder in several different directions and will test the strength of the arm. The doctor will also check for instability or other problems with the shoulder joint.
Magnetic resonance image shows a full-thickness rotator cuff tear within the tendon.
Nonsurgical OptionsIn many instances, nonsurgical treatment can provide pain relief and can improve the function of the shoulder.Nonsurgical treatment options may include:
Surgical TreatmentYour orthopaedic surgeon may recommend surgery if
Left, Arthroscopic view of the rotator cuff from within the joint shows the rotator cuff (RC), the head of the humerus (HH), and the biceps tendon (B).
RehabilitationAfter surgery, the arm is immobilized to allow the tear to heal. The length of immobilization depends upon the severity of the tear. An exercise program will help regain motion and strength in the shoulder. This program begins with passive motion and advances to active and resistive exercises. Complete recovery may take several months.
Research on the HorizonFuture developments in the treatment of rotator cuff disease include newer arthroscopic surgical techniques. These allow for smaller, less painful incisions and a faster recovery time.Many techniques now use dissolvable anchors. These hold stitches in place or hold stitches in bone until the repair has healed. They are gradually absorbed by the body.Research is also being done on " orthobiologic " tissue implants. These promote growth of new tissue in the body, and help with the healing process.