Shoulder Injury/Rotator Cuff Tear
A rotator cuff tear is a common cause of shoulder pain and disability among young sports individuals and even in elderly population leading to pain and difficulty in activities of daily living A torn rotator cuff weakens your shoulder in all ranges of movement and leads to pain and increasing difficulty in even routine daily activities like dressing / wearing clothes or even combing of hair or brushing teeth
Anatomy
Your shoulder is made up of three bones: the arm bone (humerus), the shoulder blade (scapula), and the collarbone (clavicle). The shoulder is a ball-and-socket joint: The ball, or head, of the upper arm bone fits into a shallow socket in the shoulder blade. The stability to the ball is given by the 3 rotator cuff muscles: Supraspinatus, infraspinatus and teres minor. These muscles help in shoulder movements and keep the shoulder ball in place. Any tear of any or all muscles gives rise to pain and instability and difficulty in movements. The most common tear is supraspinatus tear.
There are different types of tears:
- Partial tear: This type of tear does not completely detach the tendon from the bone. It is called partial because the tear goes only partially through the thickness of the tendon. The tendon is still attached to the bone, but it is thinned.
- Full-thickness tear: With this type of tear, there is detachment of part of the tendon from the bone.
Most of the tears are acute due to sporting injuries but a large majority are also degenerative tears due to age an overuse of the shoulder over a long period of time
Symptoms
The most common symptoms of a rotator cuff tear include:
- Pain at rest and at night, particularly if lying on the affected shoulder
- Pain when lifting and lowering your arm or with specific movements
- Weakness when lifting or rotating your arm
- Crepitus, or a crackling sensation, when moving your shoulder in certain positions
Nonsurgical Treatment
In about 80 to 85% of patients, with partial tear nonsurgical treatment relieves pain and improves function in the shoulder. Nonsurgical treatment options may include:
- Rest.
- Activity modification.
- Nonsteroidal anti-inflammatory drugs (NSAIDs).
- Strengthening exercises and physical therapy.
- Steroid injection.
Surgical Treatment
Surgery may be a good option for you if:
- Your symptoms have lasted 6 to12 months.
- You have a large tear (more than 2 cm) and the quality of the surrounding tissue is good.
- You have significant weakness and loss of function in your shoulder.
- Your tear was caused by a recent, acute injury.
Surgical Repair Options
The type of repair performed depends on several factors, including:
- Your surgeon’s experience and familiarity with a particular procedure
- The size of your tear
- Your anatomy
- The quality of the tendon tissue and bone
The three techniques most commonly used for rotator cuff repair are:
- Traditional open repair
- Arthroscopic repair : the most common one used
- Mini-open repair