ROTATOR CUFF TEAR
What is the Rotator Cuff and what does it do?
The rotator cuff is a large tendon comprised of four muscles which combine to form a “cuff” over the upper end of the arm, the head of the humerus. The four muscles supraspinatus, infraspinatus, subscapularis and teres minor originate from the “wing bone,” the scapula, and together form a single tendon unit that inserts on the greater tuberosity of the humerus.
The rotator cuff helps to lift and rotate the arm and to stabilize the ball of the shoulder within the joint.
What is a Rotator Cuff Tear?
A Rotator Cuff tear is a frequent cause of pain and disability amongst adults. As of 2008, almost 2 million US citizens approached their doctors.
A Rotator Cuff Tear is a tear of one or more of the tendons of the 4 rotator cuff muscles. Symptoms of injury to the rotator cuff can include irritation or damage to the rotator cuff muscles or tendons.
Subscapularis is the most anterior of the rotator cuff tendon-muscles. It works to internally rotate the arm. Isolated Subscapularis rupture represents 30% of all rotator cuff ruptures. Rupture of this tendon, significantly weakens the internal rotation of the arm and may make the biceps tendon unstable resulting in a very painful shoulder.
A rotator cuff may tear due to multiple reasons – an acute injury from a fall or chronic wear and tear with degeneration of the tendons. Impingement of the front of the scapula, the acromion, on the tendon is believed to be a major cause of cuff tears in individuals older than 40 years.
Typically, you may experience pain in the front of your shoulder, running down the side of your arm. It may increase when you indulge in overhead activities like lifting or reaching, or also when you sleep on the affected side. If the tear occurs with injury you may experience acute pain, a snapping sensation, and immediate weakness of the arm.
Since the rotator cuff dynamically stabilizes the shoulder joint and is important in movements of the arm, its integrity is important in normal functioning and working of the shoulder and arm.
The type of repair performed is based on the findings at surgery. A partial tear may require only a trimming or smoothing procedure called a debridement. A full-thickness tear within the substance of the tendon can be repaired side to side. If the tendon is torn from its insertion on the humerus, it is repaired directly to bone.
Three techniques are used for rotator cuff repair:
- Traditional open repair
- Mini-open repair
- Arthroscopic repair
- Your orthopaedic surgeon can recommend which technique is best for you.
The rotator cuff may tear / rupture from its insertion on the humerus due to trauma, overuse, degeneration or gradual weakening over a prolonged time. This condition is diagnosed by signs / symptomology as per patient, clinical examination as per the doctor and then further diagnostic modalities like MRI may be used to confirm the diagnosis.
Treatment consists of
- NSAID’S and painkillers
- Arthroscopic repair
- Small and partial tears may be treated with physiotherapy, steroid injections and NSAID’s. Full thickness tears may require Arthroscopic repair of the cuff.
Rotator cuff tears were historically treated by open and mini open repair of the tendon. However, since mini open and open repairs result in Deltoid weakness and postoperative morbidity, Arthroscopic repair is the current internationally accepted method of treating the tears of Rotator Cuff tendons
Arthroscopy is a minimally invasive method by which the shoulder joint is visualized without cutting the skin or muscles. An Arthroscope is a telescope, which can be inserted inside the shoulder joint by a small skin puncture, thus obviating the need for cutting open the skin and dissecting the muscles. By direct visualization of the shoulder joint and rotator cuff muscles, the tear can be repaired at the same time with the help of special arthroscopy instruments.
During the 6 weeks after the repair, your hand is in a sling and your shoulder undergoes progressive rehabilitation with the help of exercise advised by your doctor. After 6 weeks you start active assisted exercises and also progressively resume activities.
Can rotator cuff tear be treated by conservative methods non-operatively like medicines and exercise?
Generally small and partial tears can be treated conservatively with the help of physiotherapy and medicines. Big and full thickness tears of the rotator cuff are better treated with Arthroscopic repair.
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