Rotator Cuff Tears
The rotator cuff is a composite of tendons from four muscles that originate from the shoulder blade. Unlike other joints of the body, the shoulder joint is completely dependent on the soft tissues of these tendons and a capsule to stabilize the joint. Ligaments, capsule and this rotator cuff allow the shoulder move in motions that other joints cannot do.
To tear a tendon in the shoulder can be an extremely painful experience. Most people in their middle age years who have shoulder pain usually have not torn their rotator cuff tendons. Other clinical entities such as impingement, arthritis, and overuse type injuries can cause the pain, and often this is confusing. As we older, attrition and degeneration of these tendons can occur. The makeup of the tendons becomes weaker, and gradual deterioration can occur leading to a tear.
Athletes involved in overhead sports often have rotator cuff problems, but complete tearing is rare. Partial thickness tears and tendonitis make up the bulk of the rotator cuff injuries in younger people. As we age, however, these tendons can become degenerated and lose their strength. Full thickness tears where the tendon actually separates away from the ball of the joint are common in older individuals.
Symptoms of rotator cuff tears include inability to sleep on the shoulder at night, pain that radiates to the neck, and in extreme cases complete loss of ability to raise the arm above the horizontal plane. The classic sign of a rotator cuff tear is complaint of pain directly over the side of the arm. In younger athletes, a precipitating shoulder injury can cause a full or direct tear, and continued inability to perform the given sport secondary to pain is often the rule.
Forceful swinging of the arm above the head in certain sports such as tennis or throwing a baseball can create high energy forces around the tendinous restraints of the shoulder joint. Shoulder instability, where the ball and socket do not sit tightly together, can lead to structural changes in the tendons of the rotator cuff. Fraying of the tendons is often seen on arthroscopy, and often simple inflammation and redness is found.
Diagnosis is key to deliver the best possible care to a rotator cuff injury. If there is no functional deficit in the movement of the shoulder, we try physical therapy first strengthen these tendons and promote a good blood supply to the injured areas. Blood will deliver vital nutrients and healing factors to the inflamed tendons, and unless torn to a certain degree, elimination of the pain can be achieved.
Diagnostic tests such as X-rays help to study certain bone formations of the shoulder, as we know certain bone structures can lead to rotator cuff pathology. X-rays also help us see subtle changes that can lead one to the correct diagnosis as well. MRI's are probably the gold standard, as they visualize the soft tissues around the shoulder extremely well. Ultrasound can be used as well to make a diagnosis, but this is not done too often.
If surgery is indicated, people can expect 3-6 month recovery. Strict precautions on using the arm for any lifting must be followed, and home rehabilitation has proved very success in our practice. We seldom need to send individuals to private therapy, as they do quite well on the home program. The surgery often can be done arthoscopically as an outpatient procedure.
Individuals who have rotator cuff tears and require surgery achieve significant pain reduction, ability to function in their every day life with out discomfort, and the best benefit of all is regaining the full night's sleep that has been non-existent for too long.