Rotator Cuff Injury - Torn Rotator Cuff

The shoulder joint is an incredibly complex creation, comprising tendons, muscles and bones, which work together to give your arm the kind of range of motion it has. The only drawback to this wide range of motion is a deficiency of stability, which is why the shoulder joint is susceptible to injury. Basically, the shoulder comprises 3 bones, along with the tendons of 4 muscles. A tendon is a band or cord of relatively inelastic tissue, which connects muscle to bone. The bones in the shoulder are known as the clavicle, the humerus and the scapula. Or, in common terminology, the collarbone, the bone of the upper arm, and the shoulder blade.There are 4 muscles in the shoulder joint, known as the subscapularis, the teres minor, the infraspinatus, and the supraspinatus. The range of movement that you experience in your arm is due to the tendons of these muscles.

Have you ever pushed a heavy weight and heard a sudden pop go off in your shoulder? Or perhaps, while driving a golf ball, have you ever felt a sudden, sharp pain in the shoulder? These are signs of rotator cuff injury, or a shoulder injury, or a torn rotator cuff. Whatever you may call it, it basically means the same - an inflammation, strain or tear of the tendons and muscles of the shoulder.

Causes of Rotary Cuff Injury

Most rotary cuff injuries are caused by two main reasons. One being due to wear and tear, or degeneration. This condition in medical terms is referred to as degenerative tear. The problem with the shoulder is that being a tendinous region of the body it gets limited blood supply, thus the tendons get very little nutrients and oxygen, which is the reason they are particularly susceptible to degeneration due to aging. This is the reason shoulder problems are so common in the elderly. This deficiency in the blood supply is also the reason shoulder injuries take a long time to heal.

Repetitive stress to the said part of the body also have a major role in causing this condition. In some cases, it is seen that bone spurs contribute to this condition. When the arm is lifted upwards, the spur rubs against the tendon in the rotator cuff, causing a condition called shoulder impingement, which over a period causes the tear.

The second reason for most injuries of the shoulder is because of over-strain or putting excessive force on the tendons in the shoulder, also known as acute tear. This generally happens when force is put on the arm when it is in an awkward or unusual position. Jerking motion, injury can also cause this kind of tear.

Symptoms of Torn Rotator Cuff

Two of the most common symptoms of a rotator cuff injury are pain and weakness. Usually people with a torn rotator cuff find it difficult to pinpoint the exact area of the pain, and have a tendency of describing it as a vague discomfort that gets aggravated with particular movements of the shoulder. The pain is usually felt towards the exterior part of the shoulder and sometimes even along the arm down to the elbow.

Most patients complain of shoulder weakness. The weakness caused by a rotator cuff tear usually manifests itself by loss of movement by the arm such as the inability to lift the arm overhead, reach behind for something, sleep on the troubled side or to extend it to the front or side. Usually, the larger the rotator cuff tear, the more difficult it is to move the arm as well as the injured area. In some cases, there is a crackling sound heard, when the affected hand is moved in a particular position. If the arm is not used for an extended period, stiffness in the joint will be observed.

It is observed that the rotator cuff caused suddenly is the one which is often very painful. On the other hand, rotator cuff caused over a certain time the pain is mild, but will be accompanied by weakness in the arm. Depending on the actual condition, popping and cracking sound will be observed in either of the condition.

Treatment for Torn Rotator Cuff

One of the most important things is to treat rotator cuff injury as soon as possible. The first 48-72 hours are vital to recover speedily and completely. The best treatment as soon as injury occurs is to use the R.I.C.E.R., or Rest, Ice, Compression, Elevation and Referral, procedure.

Once this procedure is applied, say for about 48-72 hours, the next thing that can be done is to increase the blood supply to the rotary cuff area, so that it gets the nutrients and oxygen it requires to heal. The best way to do that is to apply heat. Heat, in fact, is one of the best ways to increase blood flow to most parts of the body. You can use heat lamps for this, or perhaps a heat-based cream.

The next method of treating a rotator cuff injury is to massage the area. A massage not only increases the blood flow into the affected area, but can also help in reducing the scar tissue, usually associated with tendon and muscle tears and strains.

And finally, it is important not to stop moving the rotator cuff. Gently moving the affected part is another way to keep the area supplied with blood. Of course, if it hurts, you will need to limit the range of motion, but it is important not to keep the area completely still. Consult your physician about this and various other methods of treatment that you apply.

When does an Injured Rotator Cuff need Surgery?

While rotary cuff surgery is usually not required, sometimes it may be resorted to. Deciding on when a torn rotator cuff will need surgical intervention will be dependent on various factors, such as:

1. Response to treatment: If other forms of non-surgical treatments prove to be ineffective even after a several months, rotator cuff surgery may be recommended.
2. Extent of the Symptoms: People who experience incessant pain, or find it problematic to carry out everyday activities like lifting objects in the house, or getting dressed, or experience pain during the night so that sleep is interfered with, will be advised surgery.
3. Type of Rotator Cuff Tear: If the rotator cuff tear is large, the muscle may be weakened irreversibly. This kind of tear will benefit from surgical intervention.

Types of Surgery performed to treat Rotator Cuff

There are several types of surgery available to treat a rotator cuff tear. Three of the procedures commonly used are:

• Open surgical procedure: Wherein a 6-10 cm long incision is made to repair the torn rotary cuff. The advantage of this method is that the tendons are seen easily, but due to the extent of the incision, the recovery can often be painful and long.
• Miniature open surgical procedure: In this surgical method a 3-4 cm incision is made and the rotary cuff is viewed through an arthroscope to clear out bone spurs or damaged tissue. Since the incision is small, the recovery is faster.
• Arthroscopic surgical procedure: Here, tiny incisions are made through which an arthroscope with a small camera is inserted and the repair is carried out by the surgeon while he/she views the process on a TV monitor. This is a relatively new procedure for treating torn rotator cuffs, and not all kinds of rotator cuff injuries can be treated by this method.

Before prescribing any of the surgeries, the patient will be advised X-rays or MRI to judge the exact nature of the condition. If with non-surgical treatment the condition can be treated, then the patient will be prescribed non-surgical methods only. The specialist will be the best person to advise the patient for or against any of the surgical procedures.