Rotator Cuff Tear

What is a rotator cuff tear? with Dr. James Spears

The rotator cuff is a group of muscles and their tendons located around the shoulder joint. The combined action of the rotator cuff muscles are to stabilize the arm bone within the shoulder joint during movements. The function of the rotator cuff muscles allow the shoulder complex to reach overhead and move the arm quickly in multiple directions.

Anatomy
The shoulder joint is comprised of the humerus (arm bone), scapula (shoulder blade), and the clavicle (collarbone). The shoulder blade and the collarbone meet to form the socket of the shoulder's ball and socket joint. The ball and socket is stabilized with the help of the rotator cuff muscles. The rotator cuff is comprised of four muscles including the supraspinatus, subscapularis, infraspinatus, and teres minor. The combined action of this muscle group is to depress or stabilize the arm bone within the shoulder joint.

Causes
The rotator cuff is often injured when someone falls onto an outstretched hand, or the arm is pulled forcefully away from the body. The traumatic forces of the fall or stretch typically cause tearing of the tendinous portion of the rotator cuff. Repetitive overhead activity such as laboring work or overhead throwing can also cause inflammation or injury to the rotator cuff muscles. Initially, injuries of this type begin as a simple overuse injury and can often be addressed with rest and rehabilitation. However, continued overhead activity can eventually cause rotator cuff damage.

Symptoms
Pain associated with rotator cuff injuries is often located near the top of the shoulder and may radiate down the upper arm. Pain will typically worsen when a person reaches away from the body or behind the back. Shoulder weakness and loss of motion may accompany pain as well. Some people will also report a heavy feeling in the arm or shoulder. These symptoms will often cause functional limitations in many activities of daily living, such as reaching, carrying, or pushing objects.

Diagnosis
A rotator cuff injury is diagnosed at first by a clinical examination from a medical professional. A physical examination can identify weakness, limitations in range of motion, and painful areas within the shoulder. In some cases, a physician may order imaging tests such as X-rays, an MRI, or a CT scan to help identify the extent of the injury.
 
Treatment
While injuries to the rotator cuff are painful, many of these injuries can be treated conservatively. Many people benefit from a course of anti-inflammatory medications to reduce pain and rehabilitation to restore strength and range of motion. Many rotator cuff strains or partial tears will heal with rest and rehabilitation over the course of 6-12 weeks. More severe injuries may require additional treatment or longer healing times. If continued pain and functional limitations exist, there are surgical options available to help repair a rotator cuff and restore its function.

Surgery
Rotator cuff repair surgery is performed by an orthopedic surgeon. The primary goal of surgery is to restore function of the rotator cuff by attaching the torn tendon back to the bone.

Recovery
Recovery from rotator cuff repair surgery is better now than it used to be, but it is still a long process. After surgery, a patient will typically wear a sling for 4-6 weeks to protect the healing repair. During the initial recovery phase, patients will typically start physical therapy to help maintain and restore shoulder range of motion. Once the patient has reduced pain and a majority of their range of motion back, it is safe to start strengthening the rotator cuff and other shoulder muscles.

For a successful outcome after rotator cuff repair, a patient must complete range of motion and strengthening exercises for at least 4-6 months to return to previous levels of activity and be successful with functional activities. For those returning to aggressive athletic activity or manual labor, a longer course of rehabilitation may be needed to achieve high-level activities.

Prevention
The best way to prevent rotator cuff injuries is with proper flexibility, and shoulder blade and rotator cuff strengthening exercises to reduce stress and strain on the shoulder. Promoting good posture, improving throwing mechanics, and adjusting work stations are all ways to reduce stress and strain on the shoulder and prevent injury.