Shoulder Injury – Rotator Cuff Tear

What Is A Rotator Cuff Injury?

A torn rotator cuff in the shoulder is a common accident related injury. The shoulder allows for complex movements, which also puts it especially at risk for injury. The rotator cuff includes muscles and tendons that protect the shoulder and facilitate the raising and rotation of the arm. The muscles and tendons that make up the rotator cuff keep the shoulder joint supported, protected and in place. Rotator cuff injuries are commonly treated initially by orthopedists.

Four muscles make up the rotator cuff:

• Suprapinatus, holds the humerus, or upper arm bone, in place and creates stability;
• Infraspinatus, the main muscle involved in rotation;
• Teres Minor, the smaller muscle of the rotator cuff, which contributes to the arm’s rotation in the opposite direction of the body;
• Subscapularis, connects the humerus to the shoulder blade, facilitating arm rotation. It also assists with straightening and lowering of the arm.

A tendon separately connects each of these muscles to the head of the humerus locking it into place. Tearing of any tendon or muscle results in a rotator cuff tear diagnosis.

How Is The Shoulder Affected With A Tear In The Rotator Cuff?

An injury to the rotator cuff as a result of an accident is common. The extent of the impairment that results from the injury will depend on the severity and location of the tear. At times, the lubricating sac in the shoulder joint called the bursa, may become inflamed and painful as a result of a tear in one of the tendons.

There are many torn rotator cuff symptoms. Shoulder movements can be limited and painful when one or more of the rotator cuff tendons are torn. Tears can be complete or partial. At times a tear can become progressively larger. The impairment associated with a rotator cuff tear is a progressive condition and can prevent one from using the shoulder joint to its full capacity.

Once shoulder function is impaired, the reduced range of motion will limit one’s ability to perform daily activities. One might also experience severe pain with movement as well as at rest. There may also be weakness in the affected muscles with associated shoulder stiffness. Certain movements, such as shoulder flexion and abduction, might also be restricted.

What Causes Rotator Cuff Injury?

A rotator cuff tear is a common injury that can result from a car crash. If one’s hand is on the steering wheel when the car is impacted, the force of the impact may drive the humerus, or upper arm bone, into the shoulder joint. This can result in excessive forces on the rotator cuff muscles and tendons, and can result in tears. Falls are also often responsible for acute tears to the shoulder, especially if one falls on an outstretched arm. Lifting heavy objects with sudden force can also tear the rotator cuff muscles and/or tendons.

Repetitive stress on the rotator cuff muscles can cause degenerative tears. This type of progressive damage is seen in professional athletes, whose shoulder joints perform the same movements over and over again. These tears can also appear as an occupational hazard, and are common with painters, movers or carpenters.

Clinical examination

The doctor, usually an orthopedist, will assess the extent of the injury by examining the shoulder and taking a medical history to learn more about the onset of the pain. The doctor will perform a physical examination which will include testing the stability, strength and range of motion of the shoulder.

The clinical examination can suggest a partial or complete tear in the rotator cuff. However, medical specialists will often rely on imaging studies, such as an MRI, to confirm the diagnosis. MRI imaging allows the doctor to more definitively diagnose the tear, as well as any other damage that may exist in the shoulder joint.

What Treatment Is Available For Tear of the Rotator Cuff?

For less severe cases, conservative treatment solutions are recommended. This includes rest and anti-inflammatory medications. Steroid injections can also help with severe pain, although these types of injections offer only temporary relief.

Physical therapy remains one of the best methods of treatment for those diagnosed with a torn rotator cuff. In the acute phase, the physical therapist will work at relieving pain. As pain subsides, a plan to restore the shoulder’s joint flexibility and strength is usually developed. Physical therapy is also common after shoulder surgery, to restore strength and mobility in the shoulder joint.

When therapy is not effective or contraindicated, surgery may be required. Arthroscopic rotator cuff tendon repair is a modern and minimally-invasive procedure, offering the advantage of a quicker recovery. For extensive tears, however, an open tendon repair may be necessary. This type of surgery will usually require a longer period of recuperation. Your doctor will decide which surgery is best for you based upon your diagnostic testing and his or her clinical findings.

What Is The Prognosis For A Tear In The Rotator Cuff?

A patient’s prognosis following a rotator cuff injury is dependent on many factors, including the severity of the injury and type of medical intervention. It is always best to speak with your doctor to get his or her best judgment as to what you can expect over time given the nature and extent of your injury.