The tendons of four muscles (infraspinatus, supraspinatus, subscapularis and teres minor) in the upper arm form the rotator cuff, blending together to help stabilize the shoulder. Tendons attach muscles to bone and are the mechanisms that enable muscles to move bones. It is because of the rotator cuff tendons, which connect the long bone of the arm (the humerus) to the scapula (the shoulder blade) that we can raise and rotate our arms.
The rotator cuff also keeps the humerus tightly in the socket (glenoid) when the arm is raised.
The tough fibers of the rotator cuff bend as the shoulder changes position.
For normal shoulder function, each muscle must be healthy, securely attached, coordinated, and conditioned.
When there are full or partial tears to the rotator cuff tendons, movement of the arm up or away from the body is impaired, making it difficult or impossible to rotate the arm in its ball-and-socket joint.
Patients with rotator cuff tears in particular, also complain of not being able to sleep on the affected side, and muscle weakness especially when attempting to lift the arm. A fully ruptured tendon may make it impossible to raise the arm or move it away from the body.
A history of shoulder problems raises the suspicion of possible rotator tear. Risk factors for tears include repetitive overhead activities, such as pitching a ball or painting a ceiling, excessive force with a fall, heavy lifting, and any degeneration or abrasion of the tendons.
Diagnosis of a rotator cuff tear is fairly easy to make on physical exam based on the patient’s active range of motion at the joint. A special test called an arthogram is often used to affirm a rotator cuff tear.
If a tear is determined to only be partial, conservative therapy will be initiated to control pain and promote healing.
The treatment regimen known as R.I.C.E. can be very effective in some cases.
It is important to rest the injury, as well as to initiate physical therapy as soon any acute pain has subsided. Anti-inflammatory medications such as non-steroid anti-inflammatory drugs (NSAIDs) are often prescribed for pain relief.
If the recommendations of a physical therapist are followed on an ongoing and continuous basis, many partial tears will become very manageable with this treatment.
If necessary, cortisone injections may be given if pain continues several weeks after conservative therapy is initiated. However, cortisone should not be used long term, as it may weaken the tendons.
If the tear extends through the complete thickness of the tendon there are several surgical options depending on the size, depth, and location of the tear. If other problems with the shoulder are discovered during the surgery, they will be corrected as well.
Recovering from shoulder surgery takes time, full recovery taking at least 6 months. Success of recovery is largely based on commitment to the exercise program your surgeon prescribes.
Although each case is unique, shoulder surgery usually results in relief of pain and restoration of functional range of motion with compliance and hard work.
A consultation with an orthopedic doctor is the fastest and safest way to diagnose rotator cuff tear. If you feel you are suffering from a rotator cuff tear, request an appointment today.