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Institute of Advanced Orthopedics, MOSC Hospital and Medical College, Kolenchery, Ernakulam, Kerala

Rotator Cuff Tear

Shoulder Anatomy

Normal Rotator cuff

The shoulder complex is made up of three bones; the humerus, scapula and clavicle. Your shoulder is the most mobile joint in your body and is therefore dependent on strong muscles to move and stabilise it. Some of the most important muscles for this purpose are the rotator cuff muscles.

The rotator cuff is a group of muscles closely wrapped around the top of your arm (humerus). These muscles originate from your shoulder blade and their tendons form a hood covering the ball of your socket joint. These tendons can be damaged through general wear and tear, or after an accident/fall. If one or more of these muscles are damaged, movement may become difficult and the shoulder becomes weak and painful.

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What Is a Rotator Cuff Tear?

A rotator cuff tear is a rip in the group of four muscles and tendons that stabilize your shoulder joint and let you lift and rotate your arms (your rotator cuff). There are two kinds of rotator cuff tears. A partial tear is when one of the muscles that form the rotator cuff is frayed or damaged. The other is a complete tear, meaning it all the way through the tendon or pulls the tendon off the bone.

Side view of Rotator cuff (Supraspinatus) tear

It’s a common injury, especially in sports like baseball or tennis, or in jobs like painting or cleaning windows. It usually happens over time from normal wear and tear, or if you repeat the same arm motion over and over. But it also can happen suddenly if you fall on your arm or lift something heavy.

Diagnosis

Rotator cuff tears are diagnosed by careful clinical examination. Ultrasound scan of the shoulder joint is used to screen a rotator cuff tear.

It can be confirmed on MRI (magnetic resonance imaging) scans. The type and extend of the tear , muscles involved and the condition of the muscles can be assess accurately on a high resolution (3 Tesla) Mri scan. As the rotator cuff muscles are soft tissues, they will not show on routine X-rays or CT scans.

Normal MRI scan
Rotator cuff tear (Supraspinatus) as seen on MRI scan

Conservative treatment

Rotator cuff tears which involve less than 50% of the thickness respond well to focused rotator cuff rehabilitation physical therapy. The help of a good shoulder trained physical therapist is very usefull to make you go through the process.

For details please read- Shoulder Rehabilitation program

PRP therapy for rotator cuff tear

Partial rotator cuff tears can respond to PRP therapy. You can read about this on PRP therapy for Rotator cuff tear

What happens when a rotator cuff tear is not treated on time?

If a rotator cuff tear is not treated on time, the tear size can increase and the muscles undergo retraction and infiltration with fat. As the muscles of the rotator cuff are connected, a tear in one of them caused progression into the adjoining muscles. It can become irreparable as time progresses. It is like the saying “a stitch in time saves nine“.

Different types of rotator cuff tear with progressing dimension

What is a rotator cuff repair?

The operation aims to repair the damage to the torn muscles or tendons. Once you are under a general anaesthetic the torn muscles are repaired using sutures or suture anchors depending on the type of damage. Often a ligament is also released and a piece of bone may be shaved or cut away to allow more space for the repaired tendon to heal.

The operation may be done arthroscopically (key hole surgery) or rarely, through an open incision.

Anchors inserted for repair of Rotator cuff (Arthroscopy Image)
Rotator cuff double row repair (Arthroscopy Image)

Advantages of Arthroscopy

There are two major benefits of arthroscopic rotator cuff surgery.

The main benefit of rotator cuff surgery in general is to eliminate pain from a partial or total rotator cuff tear. The benefit of having this surgery done arthroscopically is that it is minimally invasive and has a quick recovery time. The arthroscope allows the surgeon to make very small cuts rather than a large incision for open surgery.

Surgical Repair Options

There are a few options for repairing rotator cuff tears. Double row and single row repair options are available. Double row repair gives a strong footprint compression of the rotator compression thereby ensuring good tendon healing to bone.

Double row Vs Single row rotator cuff repair

FAQ about rotator cuff repair

How does a rotator cuff tear cause shoulder & neck pain?

If left untreated a rotator cuff tear can cause pain in the neck and back of the shoulder radiating to the outer aspect of the arm. There will be an increase in strain on the neck muscles and the deltoid muscle which are the secondary muscles which help to lift the arm. When the rotator cuff is not functioning, the shoulder and arm muscles tend to work more causing pain over the outer aspect of the arm. Some people develop swelling over that area with pain.

Over working of the deltoid muscle can cause impingement of the shoulder ball (humerus) under the acromion and thereby injure the rotator cuff tendons, leading to an increase of the rotator cuff tear dimension.

Shoulder Impingement

 

 

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