Rotator cuff tears are a common cause of shoulder pain. Tears can be acute or chronic, and may be treated conservatively or surgically.
Rotator cuff tears - an overview
Rotator cuff tears are a common cause of shoulder pain. The rotator cuff is a group of four muscles that form a musculotendinous covering, or "cuff", that surrounds the top of the upper arm bone (head of the humerus). Tears of the rotator cuff can occur in people of almost any age, but are most common over the age of 40. Rotator cuff tears may be due to a number of different causes. Tears in older individuals are often chronic, due to years of "wear and tear" of the tendons. Tears in younger people are often due to repetitive overhead arm motion, or may be due to a single acute injury. Tears may cause varying degrees of pain, or may be entirely without symptoms in some individuals. Diagnosis of rotator cuff injuries is made by physical exam, followed by imaging with x-rays, ultrasound scanning, and/or MRI scanning. Treatment of rotator cuff injuries varies, and can include conservative measures such as rest, and physical therapy, to more aggressive treatment such as steroid injection into the shoulder joint, and surgery.
What is the rotator cuff?
The rotator cuff is a group of four muscles: the supraspinatous, the infraspinatous, the subscapularis, and the teres minor. The tendons of the muscle form a cuff, covering the head of the humerus (upper arm bone). The rotator cuff stabilizes the shoulder, and allows for the unique rotational motion of the shoulder joint.
How do most tears of the rotator cuff happen?
Most tears are the result of overuse of the muscles and tendons over the years. Other tears occur from an acute injury, either in isolation, or along with a fracture of the humerus or a shoulder dislocation. Individuals most at risk for overuse-type tears are those who participate in activities requiring repetitive, overhead motion.
What are the symptoms of rotator cuff tear?
- Pain, usually at motion. May radiate down the side of the arm.
- Limited range of motion.
- Atrophy of the muscles surrounding the shoulder.
How are rotator cuff tears diagnosed?
The first step in diagnosis of a rotator cuff tear is physical examination of the shoulder. The doctor will check:
- Range of motion of the joint.
- Presence or absence of crepitus (cracking of the joint with motion).
- Soft tissue defect in the area of the rotator cuff.
- Muscle atrophy.
Imaging of the shoulder usually follows. Plain x-rays don't show the soft tissues of the rotator cuff, but will demonstrate bony spurs near the rotator cuff. Next, an MRI scan will usually be performed. This imaging procedure is very sensitive and specific for rotator cuff injuries. Ultrasound scanning may also be used in some specific settings.
How are rotator cuff tears treated?
In general, conservative, non-surgical treatment is initially employed for most rotator cuff tears. Rest, anti-inflammatory medication and physical therapy will often help relieve the pain associated with the tear. If pain persists after a course of conservative therapy, surgical repair of the tear will usually be recommended. There are several surgical options for rotator cuff tear repair, depending on the size, shape and location of the tear. Surgery can be performed arthroscopically, using a small incision and a thin fiberoptic scope, or an "open" procedure using a larger incision, may be required. Surgery, however, is not a guarantee of pain relief, with approximately 50-80% of post surgical patient reporting pain relief, according to various studies.
The statements above are for informational purposes only. Please see your doctor for appropriate diagnosis and treatment of any illness.
Reference:
American Academy of Orthopedic Surgeons
