Your shoulder is a ball-and-socket joint. It is made up of the humerus (arm bone), scapula (the shoulder blade), and clavicle (the collarbone).
A group of four muscles covers the head of the humerus by coming together as tendons. They are called rotator cuff muscles. They attach the humerus to the shoulder blade. They help in lifting and rotating your arm. Bursa, a sac with lubricating fluid, is present between the acromion and rotator cuff. It helps rotator cuff tendons to glide freely during the movement of your arm. An injury to the rotator cuff tendons causes pain and inflammation in the bursa.
Rotator cuff tear
The tear in the rotator cuff tendons can be partial or complete. In a majority of the rotator cuff tear, the tendon is torn away (completely detached) from the bone. Even a partially torn tendon can completely tear if force is applied to it as with lifting a heavy object.
Types of rotator cuff tears
Partial tear: The tear occurs only through the thickness of the tendon as the tendon doesn’t detach completely from the bone. The tendon becomes thin, but still remains attached to the bone.
Full-thickness tear: In this type of tear, a part of the tendon detaches from the bone. It is known as a full-thickness incomplete tear if only a small part of the tendon detaches from the bone. Whereas in a full-thickness complete tear, the tendon detaches completely from the bone – and a hole forms in the tendon.
Acute Tear: This type of tear may result if a person falls down on his or her outstretched arm or lift any heavy object with a jerking motion. This type of tear can occur with a dislocated shoulder or a broken collarbone.
What are the causes of rotator cuff tears?
There are two types of rotator cuff tears:
- Degenerative: General wear and tear of tendons occur relatively slowly over a period of time. This type of degeneration occurs due to aging. It is natural and relatively painless. However, there are several factors that contribute to chronic or degenerative rotator cuff tears.
Repetitive work and stress: Those who play tennis, and baseball and involve in activities such as weightlifting are at risk of overuse tears. In addition, other jobs, professions, and activities can also cause overuse rotator cuff tears.
Lack of blood supply: Lack of blood supply to the tendons may result in a reduced natural tendency of the body to repair tendons if they tear.
What are the risk factors for rotator cuff tear?
Age is the major risk factor as people over 40 years of age are at increased risk due to natural wear and tear of tendons with age.
People who are involved in professions, activities, and sports are at risk due to overuse and repetitive activities. Tennis players, golfers, baseball pitchers, carpenters, and painters fall under this category.
What are the symptoms of rotator cuff tear?
The most common symptom is shoulder pain. In the acute type of rotation cuff tears that result from a fall or an injury, the pain is intense with a snapping sensation and weakness in the upper arm. The pain can also be due to other shoulder conditions.
The pain becomes worse with certain shoulder movements or while lowering or lifting the affected arm. Pain during resting or at night in the affected shoulder. In addition, rotating, or lifting the affected shoulder causes weakness. A crackling sensation is noticed while moving the shoulder in certain positions.
Diagnosis of Rotator cuff tear
Your orthopedic doctor will physically examine your shoulder and check to see whether you have inflammation, swelling, tenderness, deformity and pain. The doctor will also have you move your arm in different directions to measure the range of motion and your arm strength. To confirm the diagnosis, your doctor may recommend X-rays an MRI scan, or an ultrasound.
Treatment ensures relief from symptoms, prevents symptoms from getting worse, and early return to work. Your orthopedic doctor will formulate an appropriate treatment plan based on your age, overall health, activity levels, and the type of tear you have.
In a majority of people, nonsurgical treatment relieves pain and improves the function of your shoulder. It involves rest, activity modification, and use of medication and steroid injections. In addition, your doctor will also recommend physical therapy and strengthening exercises.
However, the disadvantage of this type of treatment is that you have to limit your activities. And also, the size of the tear may increase over time.
Rotator Cuff Repair Surgery
Surgery remains the best option if nonsurgical methods do not offer any relief from symptoms. If you have persistent pain or if you are very active in your activities or sports with a rotator cuff tear, then your orthopedic doctor will recommend surgery.
You should immediately see your doctor if you have symptoms for more than 5 to 6 months or more with significant loss of function in your shoulder with weakness.
If you have shoulder pain with movements and lifting weights or with any other activity, then see your orthopedic doctor. If you keep delaying despite the pain, the damage or tear may further increase and the tear may get larger over time with increasing pain and worsening shoulder function.