Rotator Cuff Tear

The rotator cuff, made up of muscles and tendons in the shoulder, allows you to lift and rotate your arms. It keeps the ball of the humerus (upper arm bone) in the shoulder blade socket. A tear in the rotator cuff occurs when the tendons pull away from the arm bone. It is a common injury that increases with age. Moreover, it is especially common among people who play sports like tennis or baseball or have jobs that require repeated overhead motions, such as carpenters or painters. 

Rotator cuff tears are of two types, which include:-

1. Partial tear: An incomplete or partial tear occurs when one of the rotator cuff muscles is frayed or damaged, and the tendon is still partially attached to the arm bone. 
2. Complete tear: There is a rip or hole in the tendon in a complete tear, and the tendon gets completely separated from the arm bone.

Some rotator cuff tears do not cause pain. They could result from degenerative conditions, i.e., your rotator cuff could be damaged for months or years before the symptoms appear. But in some cases, you might experience the following symptoms:-

1. Pain or difficulty in raising your arm
2. Hear clicking or popping sounds when moving your arm
3. Shoulder pain that worsens at night
4. Weakness in the shoulder
5. Difficulty reaching behind the back or combing your hair

Accidents such as falls can cause a dislocated shoulder or broken collarbone, causing a tear in the rotator cuff (acute tears). Usually, rotator cuff tears are degenerative (chronic tears), i.e., they occur over time. The causes of degenerative tears include:-

1. Overuse: Repetitive overhead movements during sports or certain jobs can stress tendons and muscles, causing a tear. 
2. Bone spurs: Bone overgrowth on the top of the shoulder bone can rub against the tendons when you lift your arm, creating friction between the bone and the tendon. As a result, a tear may occur eventually. 
3. Decreased blood flow: Muscles and tendons require a healthy blood supply to repair themselves. However, as you age, the blood supply to the rotator cuff decreases, resulting in a tear. 

A rotator cuff tear can occur to anyone. However, your risk of rotator cuff tears can increase with the following factors:-

1. Age: Rotator cuff tears usually occur in people older than 40.
2. Family history: The risk increases if you have a family history of rotator cuff injuries or shoulder problems. 
3. Smoking: People who smoke are at a high risk of having rotator cuff tears. 
4. Poor posture: Moving your arm while sitting in a slouched position can increase your risk of rotator cuff tears. 

The risk of degenerative tears is more common among people who stress their rotator cuff, such as:-

1. Construction workers
2. Painters
3. Carpenters
4. Mechanics
5. Athletes who participate in sports like weight-lifting, tennis, or baseball

Your doctor will perform a physical test by pressing on different parts of the affected shoulder and moving your arm in different positions. The doctor checks for shoulder tenderness, arm strength, and range of motion during this physical exam. To confirm the diagnosis, you may get imaging tests, including:-

1. X-rays: These tests can visualise bone spurs and check for arthritis. 
2. Ultrasound: The test uses sound waves to see the soft tissues, such as tendons and muscles in your shoulder. It also allows the doctor to compare the affected and healthy shoulder. 
3. MRI: It uses sound waves and a powerful magnet to obtain detailed pictures of your shoulder’s structures and look for tendon tears.

Sometimes, treatments such as ice, rest, and physical therapy can help you recover from a rotator cuff tear. About eight out of ten people with partial tears get better with non-surgical treatments, which can help strengthen your shoulder muscles. 

Non-surgical treatments include:-

1. Rest and an arm sling: Modifying your activities and using an arm sling can provide your shoulder the time to heal. 
2. Non-steroidal anti-inflammatory drugs (NSAIDs): NSAIDs such as ibuprofen or acetaminophen can help minimise swelling and pain. 
3. Physical therapy: It is usually the first treatment option suggested by the doctor. Exercises can help strengthen your shoulder and restore flexibility. 
4. Steroid injections: Steroid injections into the shoulder can help ease pain and swelling, especially if it interferes with sleep and daily activities. 

Surgical options for rotator cuff tears include:-

The doctor may recommend surgery if you have a complete tear or if non-surgical treatments fail to relieve the symptoms of a partial tear.

1. Arthroscopic tendon repair: The surgeon inserts an arthroscope (a small camera) and tools through small incisions to reattach the tendon to the arm bone. 
2. Tendon transfer: If your tendon is too damaged to be repaired or reattached, the surgeon may use a nearby tendon as its replacement. 
3. Open tendon repair: The surgeon uses larger incisions to reattach the torn tendon to the arm bone. 
4. Shoulder replacement: The surgery is used for severe rotator cuff tears. The surgeon removes and replaces the damaged parts of the shoulder with artificial implants. 

Please note that the selection of the treatment approach is based on your condition and your doctor’s opinion. 

The rotator cuff tear can worsen if the treatment is delayed. If left untreated, it can lead to:-

1. Chronic pain
2. Weakness in the shoulder joint
3. Permanent loss of motion

Stages of Rotator Cuff Tears

Stage 1: It is an early-stage impingement, including oedema and inflammation. This stage is characterised by pain during certain motions or positions. Performing overhead activities may be difficult. 

Stage 2: The stage involves fibrosis and tendonitis. You may experience a marked loss of motion, weakness, pain, and inflammation. Overhead activities can become difficult, and you may hear joint noise when lifting your arm. 

Stage 3: This stage is characterised by bony spurs (osteophyte) and tendon ruptures, causing weakness, decreased active motion, degenerative changes, and significant pain.