Rotator Cuff Tear
What is a Rotator Cuff Tear?
The rotator cuff is made up of a set of four muscles and tendons that cover the top of the humeral head, also allows rotation of the shoulder and elevation of the shoulder overhead. The four muscles of the rotator cuff are called the supraspinatus, infraspinatus, subscapularis, and teres minor muscle. The most common rotator cuff tear is of the supraspinatus tendon near its insertion, and the second most common is the subscapularis, and probably the third most common is the infraspinatus.
Signs and Symptoms:
Signs of a rotator cuff tear often include pain around the shoulder when raising the arm overhead. There may be a grinding sensation in the shoulder joint. Often there is pain at night when lying on the shoulder, or pain when lowering the arm from a raised position. In later stages, there may even be atrophy or decreased muscle sizes around the shoulder. Symptoms of rotator cuff tear may develop immediately after or soon after a specific trauma. Rotator cuff tear can be a slow progressive onset as well related to degenerative tearing.
Often, if rotator cuff symptoms begin to occur, rest, heat, ice, anti-inflammatories, and sometimes steroid injections are of value.
Diagnosis of a Rotator Cuff Tear:
Is based on signs, symptoms and physical exam as well as further information that can be gained from x-rays, MRI and/or ultrasound. First your doctor should take a thorough history and examine your shoulder, and then determine whether conservative treatment would be most appropriate. Sometimes shoulder pain may be related to a pinched nerve related to the neck rather than specifically to the shoulder. Most often, x-rays are taken of the shoulder to help determine if there is any spurring that may be contributing to a rotator cuff tear and any arthritis or other changes in the shoulder that may contribute to pain and symptoms.
An MRI is often used as well with or without a dye injection to better isolate and show specific tears of the rotator cuff and/or tears of the rim of the joint called the labrum. MRI also is helpful in showing whether there is a biceps tendon tear that may be a part of symptoms.
If conservative treatment is not effective, surgery may be recommended depending on the size of the tear, location and degree of tear. Surgery may be done totally through an arthroscope or may be done in a combination of arthroscopic and open.
If arthroscopic repair is chosen, a fiberoptic scope or small pencil sized instrument is inserted into the joint from different directions, certain tears allow a fixation through these small portals in the shoulder.
Mini open repair/open repair, often the arthroscope is used first to make the diagnosis to treat labral tears and/or biceps injuries through the scope and then a combined open procedure is then performed from 4- to 6-cm anterior shoulder to approach the rotator cuff for a formal repair.
The shoulder is immobilized to allow for shoulder healing. Often an interscalene block has been placed just prior to shoulder as well, which improves pain control after surgery for up to three to four days. Early pendulums are often allowed to allow the elbow range of motion and gentle gravity driven motion of the shoulder, and slow progressive passive range of motion is begun for a period of about eight weeks with the shoulder in a pillow and sling when not doing the formal exercises as prescribed. Therapy is usually supervised by occupational therapy or physical therapy. Following removal of the sling and pillow at about the eight-week point, another period of two to four months is used to progressively increase range of motion, strength, and work hardening to gain final degrees of motion and strength, depending on the type of work. Release to full work activities and sports activities is determined by the surgeon and completely depends on diagnosis, treatment, rehab progress, and needs at work and/or sports.