A group of four muscles are attached to the upper region of shoulder blade through a pair of tendons. These tendons in altogether are known as rotator cuff. These muscles and tendons are responsible for proper rotation and lifting of arm. Any damage to the tendons separate it from the bone. This is known as rotator cuff tear. These tendons tend to be sensitive to injuries or damages.
With aging, the rotator cuff becomes weak. They are, hence, easily subjected to wear and tear. Injury and degradation are the major causes of rotator cuff tear:
- Acute tear:
Injury to shoulder is often responsible for tear or damage to rotator cuff. Heavy weight lifting, fall from a height, broken collarbone and dislocated shoulder are examples of some common injuries.
- De-generative tear:
Aging is the primary factor for wear and tear of tendons. Dominant arm is more prone to rotator cuff tear. Degeneration in one shoulder creates risk for degeneration in opposite shoulder too. Factors which lead to chronic or degenerative rotator cuff tear are:
- Repetitive Stress
- Lack of blood supply
- Bone spurs
Although, rotator cuff tears are not life-threatening in nature but they induce severe pain. Some common symptoms of this condition are:
- Severe pain while resting, lifting or lowering arm, especially in night.
- Limited movement.
- Stiffness and crepitus sensation in shoulder.
The severity of the condition of rotator cuff describes the type of treatment needed. Basically non-surgical and surgical type of treatment procedure exists. Non-surgical treatments are beneficial because they avoid the risk of infection, reaction to anesthesia, and permanent stiffness. Also it requires less recovery time. However, some it accompanies some disadvantages such as no muscle strength improvement, increase in tear size, or limited daily activities.
- Non-surgical Treatment
About 50% of patients finds improvement in pain and functionality through non-surgical method. However, shoulder strength is not regained through this procedure. The options included in non-surgical treatment are:
In acute symptom condition, proper rest is essential. Rest helps the shoulder inflammation to improve. Sling is sometimes preferred to hold still and protect the shoulder. However, complete immobilization of shoulder is not recommended as it may cause frozen shoulder. Simple exercises which do not strain the rotator cuff are favored.
- Activity Modification:
Avoid activities which creates stress on the rotator cuff and hence increase pain. Such activities include heavy lifting, vigorous activities, irregular sleeping position, etc.
- Non-steroidal ant-inflammatory medication:
The control of symptoms is greatly possible with the intake of anti-inflammatory medications. Pain and swelling in affected areas is reduced with these medications. Naproxen and ibuprofen are the commonly used medications. These medications are often prescribed, under the supervision of a doctor, for a short period of time.
- Physical therapy and strengthening exercises:
For proper treatment of rotator cuff injury, it is essential to have strengthened muscles. Physical therapy is a good option to restore lost strength and mobility of the muscles. It includes exercises which are simple and prevent recurrence of shoulder pain. Stretches help to improve range of motion and reduces any discomfort to shoulders.
- Steroid injection:
Steroid injection such as cortisone is useful to limit the symptoms of rotator cuff tear. Injections provide temporary relief from pain and inflammation. So it is recommended to use physical therapy after injections to prevent chances of occurrence of shoulder discomfort.
- Surgical Treatment
In case, the symptoms are not improved with non-operative methods, then surgery is opted. Surgery is also useful to treat tears of more than 3cm in size. The surgery helps to retain the original function of the shoulder. The surgery involves connecting the torn tendons back to the arm bone(humerus). This process is also known as rotator cuff repair. This can be done using three types of surgical method:
- Arthroscopic surgery:
In this type of surgery, the person creates small incisions on the shoulder muscles. Through these incisions, a small tube with camera and tiny surgical instruments attached at one end are inserted. This tube is known as arthroscope and is used for rotator cuff repairing.
- Open surgery:
This method makes use of normal surgical instruments to perform surgery. These instruments are inserted through a large hole made in the shoulder muscles.
- Mini-open surgery:
In mini-open surgery, both arthroscopic and open surgeries are used. The first part of the surgery is performed using arthroscope while the second part uses regular surgical instruments to repair. However, the muscles are not much affected as in open surgery and the incision created is also smaller.
Post-to-treatment a rehabilitation program is essential. It helps the patient to return to the normal daily activities. Physical therapy is an important aspect of rehabilitation program. It provides lost motion and strength of muscles. This program includes:
It uses a sling to protect the repaired tendons for faster healing. For 4 to 6 weeks after surgery the arm should not be moved.
- Passive Exercise
Passive exercises are used to improve the range of motion of the repaired shoulder. In this method, the arm is supported by the doctor and moved in different positions. These exercises are generally opted within first 4 to 6 weeks post-surgery.
- Active Exercise
After 4 to 6 weeks, active exercises are considered. Within this time, the patient will be able to move arm on his own. These exercises enhance the strength and arm control.
Result and risks:
The majority of people experiences reduced pain and enhanced strength after treatment procedure. Some factors such as patient’s age, tissue quality, type of tear, etc affects the outcome of treatment. However, some risks associated with surgical procedure include:
- Injury to nerves
- Detached deltoid
- Repeated tendon tear
- Swelling and stiffness