Rotator cuff tears are the leading cause of shoulder pain in patients and are quite common in athletes and elderly patients, with over two million rotator cuff injuries treated every year. A rotator cuff tear refers to a condition where the rotator cuff tendon is damaged or ruptured. It can be quite painful and limit the movement of the arm, depending on the severity of the tear.
Anatomy of the Shoulder Joint
The shoulder has three main bones- upper arm bone (humerus), shoulder blade (scapula), and collarbone (clavicle). Similar to the hip, the shoulder is a ball-and-socket joint, where the head of the humerus rests in a socket in the shoulder blade. The rotator cuff assembly plays an important role in keeping the humerus securely placed in the shoulder joint.
The rotator cuff assembly is a group of the below four shoulder muscles that are located surrounding the shoulder joint:
- Teres minor
This group of muscles works collectively to support and stabilize the shoulder joint. These muscles also help in the lifting and rotating movements of the arm. The rotator cuff muscles have four tendons that combine to form the rotator cuff tendon. This tendon is much larger than the others, and it attaches to the humerus at the socket.
As this rotator cuff tendon is involved in the constant motion of the arm and shoulder, it can suffer from considerable wear and tear over the years. Over time or through overuse, it can get frayed, ruptured, or even completely tear away from the bone. The rotator cuff tears can be termed partial or complete and graded from 1 to 4, depending on the degree of damage to the tendon. The associated bursa near the rotator cuff can get inflamed when the rotator cuff tendon is damaged, and this can also contribute to the pain and discomfort.
Rotator cuff tears are usually caused due to overuse or age-related wear and tear, and therefore are most common in people over the age of 40 years. These tears can also occur in younger people as a result of trauma due to direct shoulder impact, a fall or an accident.
Rotator Cuff Tear Symptoms
- Pain and tenderness over the front and outer part of the shoulder
- Pain worsens when the shoulder is moved
- Difficulty in lifting or rotating the arm
- Reduced strength in the shoulder
- Reduced movement of the shoulder
- Clicking’ or catching when moving the shoulder
Rotator Cuff Tear Diagnosis
Physical examination of the shoulder and X-ray tests can reveal whether the rotator cuff tendon is damaged. There is also a test called the ‘drop arm test’ that can help to diagnose whether there is damage to the rotator cuff tendon.
In some cases, more detailed investigations such as an ultrasound or MRI scan may be recommended by your doctor. If a complete tear of the rotator cuff is suspected, you may be referred to an orthopedic surgeon for further examinations.
Rotator Cuff Tear Treatment
Rotator cuff tears are initially treated with conventional options such as pain medications, anti-inflammatory drugs and steroid injections to manage the pain. Ice on the shoulder joint, rest, and restriction from any shoulder movement can also help ease the symptoms.
For minor tears, physical therapy can be effective in preventing the tear from worsening, by strengthening the rotator cuff muscles. For complete tears where the tendon is too frayed or completely torn away from the bone, surgery might be recommended. Surgery usually involves sewing back the damaged tendon, and widening of the space underneath the acromion. The surgery is typically done arthroscopically or through an open method.
However, surgeries to correct rotator cuff tears can have a high failure rate if the tendon is too damaged.