Rotator Cuff Tear

What is a Rotator Cuff Tear?

A rotator cuff tear is a shoulder injury impacting the rotator cuff, which comprises four muscles and tendons. These components help to stabilise and facilitate movement in the shoulder joint. Every shoulder movement engages the rotator cuff, underscoring its necessity for daily activities.

The rotator cuff is prone to various injuries, with tears being prevalent. These injuries range from strains and tendinitis to bursitis, with the most frequent tear affecting the supraspinatus muscle.

Rotator cuff tears can be classified into two types: partial and complete. In a partial tear, the tendon remains somewhat attached to the arm bone, while in a complete tear, the tendon fully detaches, creating a hole or rip in the tendon.

Causes and Risk Factors

Rotator cuff tears occur due to a combination of acute incidents (occurring from one incident) and degenerative processes (due to long-term overuse).

• Trauma to the Shoulder: This can lead to an acute injury. It typically results from specific incidents like heavy lifting, falls, or the shoulder being forced into an awkward position. Younger individuals are more susceptible to acute rotator cuff injuries.
• Age-Related Degenerative Tears: Over time, repetitive use of the shoulder leads to wear and tear of the tendons, primarily affecting people over 40. As one ages, the blood supply to the rotator cuff also reduces, impairing the tendon’s ability to repair itself and increasing the likelihood of tears.
• Repetitive Movements: Jobs requiring repetitive lifting or overhead activities, like carpentry or painting, can lead to degenerative tears. Athletes, particularly those in tennis, baseball, rowing, and wrestling, face a higher risk.
• Genetics: A biological family history of shoulder problems may predispose individuals to similar injuries.

Non-Surgical Treatment Options

While rotator cuff tears do not generally heal on their own, there are several non-surgical treatment options available that can improve symptoms and restore function.

Immobilisation of the Arm

Initially, rotator cuff tear specialists recommend resting the affected arm and avoiding activities that exacerbate pain. An arm sling can be used to restrict movement and allow the shoulder time to heal.

Cold or Heat Application

In the early stages, a rotator cuff tear specialist may also suggest using hot or cold packs on the shoulder, to help reduce swelling and discomfort.

Physical Therapy

Physical therapy involves exercises to strengthen shoulder muscles and restore range of motion. This approach can be particularly effective for partial tears.

Pain Management

This includes anti-inflammatory medications like ibuprofen and naproxen, and corticosteroid injections which can be injected into the affected area. Both can help alleviate inflammation and pain.

Ultrasound Treatment

This involves using sound waves to promote tissue healing and reduce pain. It is a form of non-invasive therapy that increases blood flow to the affected area. It is often used alongside other treatments like physical therapy to enhance healing outcomes for rotator cuff injuries.

Surgical Treatment Options

Rotator cuff surgery aims to repair the torn tendons in the shoulder. During surgery, loose fragments in the rotator cuff area can be removed (shoulder debridement) and the acromion bone can be shoved down to relieve pressure on the rotator cuff (shoulder decompression).

Three primary surgical techniques are used to achieve this:

• Open Repair Surgery
  This traditional approach involves a larger incision, typically 4 to 6 cm, over the shoulder. It allows direct access to the torn tendon. Open repair is suitable for large or complex rotator cuff tears, which require a clear view and more room to operate.
• Arthroscopic Repair Surgery
  Arthroscopic repair is a minimally invasive surgery performed through small incisions, less than 1 cm each. An arthroscope, a small camera, is inserted to guide the surgery. This technique is preferred due to its less invasive nature, leading to potentially faster recovery and less postoperative pain.
• Mini-Open Repair Surgery
  This technique combines elements of both open and arthroscopic surgery. It involves a smaller incision, typically 1 to 5 inches, and is used when more than one tendon tear is present. Mini-open repair allows for the direct visualisation of the tear through a smaller incision, while also using arthroscopy for other aspects of the surgery. It is useful for more complex tears that require both direct access and minimally invasive techniques.

Prevention Strategies

Preventing rotator cuff injuries, especially in high-risk groups, involves a combination of lifestyle adjustments, exercise, and awareness of movement techniques.

• Warm-up Before Activities: Perform warm-up exercises before engaging in activities that could strain the shoulder, such as sports or heavy lifting. Light exercises like jogging, using a stationary bike, or doing jumping jacks can prepare the muscles for more strenuous activity.
• Using Proper Technique to Prevent Injury: Use the correct form to prevent injury, especially when lifting weights or performing new exercises.
• Muscle Strengthening and Balance Exercises: Strengthening exercises for the shoulder, chest, and upper back muscles can help maintain balance and reduce stress on the rotator cuff.
• Regular Stretching of Muscles and Tendons: Keeping muscles and tendons flexible through regular stretching exercises can also play a role in preventing symptomatic rotator cuff tears.