Rotator Cuff Tears

This information has been displayed with the kind permission of Lennard Funk and SportsInjuryClinic. Parts of the pages have been copied from Shoulderdoc.co.uk and SportsInjuryClinic.net.


Clinically Relevant Anatomy

The rotator cuff is a group of tendons that connects the four muscles of the upper shoulder to the bones ( see Anatomy). The strength of the cuff allows the muscles to lift and rotate the humerus (the bone of the upper arm). Thetendons run under the acromion (part of the shoulder blade) where they are very vulnerable to being damaged. This can lead to a tear resulting in a painful, weak shoulder. A tear may result suddenly from a single traumatic event or develop gradually.

Characteristics/Clinical presentation

  • When the tendons or muscles of the rotator cuff tear, the patient is no longer able to lift or rotate his or her arm with the same range of motion.
  • Significant pain associated with shoulder motion.
  • The pain is also very common at night, often radiating down the arm.

As people age, it is normal for the rotator cuff tendon to wear and degrade. The rotator cuff becomes weak and prone to rupture or tear. A fall or wrenching injury can then result in complete rupture of the tendons. This leads to pain and weakness of the shoulder.

 

Mechanism of Injury

1. Injury, especially while trying to lift or catch a heavy object
2. Overuse, especially after a period of inactivity
3. Poor blood supply to an area of the cuff (which occurs with increasing age)
4. A fall on an outstretched arm
5. A gradual weakening of the tendons of the shoulder, often associated with impingement

Differential Diagnosis

  • Slap lesion
  • Disclocation/ Post Stabilisation
  • Sub-acromial Impingement
  • Arthritis
  • Poor scapulohumeral rhythm
  • Postural shoulder pain

Examination

Click here to look at a shoulder assessment

A rotator cuff tear is best disgnosed with a scan. The type of scan depends on the local resources and skills.

  1. Ultrasound Scan – in some cases this can be done immediately in the clinic and is accurate, dynamic and cost effective.
  2. MRI Scan – This is more costly and less accessible, but can provide information on the quality of the muscles and other underlying structures of the shoulder.

We use Office ultrasound scans in the clinic routinely and MRI scans if we need information on the muscle quality (required for some surgical procedures)

 

Click here to access more through Shoulderdoc.co.uk

Treatment

Advice to patients

  • Avoid excessive overhead activities.
  • Strengthen your shoulders and do not try to play or work through the pain.
Healthcare Professional and Physiotherapy Management
  • Painkillers and anti-inflammatory medications
  • Physiotherapy – keeps your shoulder strong and flexible and reduce the pain and weakness
  • Cortisone steroid injections – reduces inflammation and control the pain. It is advisable to avoid repeated steroid injections in the presence of a tendon tear, as this may weaken the tendon further.
  • Surgery is required –
  •        a. If the tear follows an injury
  •        b. When pain and weakness is not improved with injections and physiotherapy
  • The goal of any surgery is to relieve the pain and improve the shoulder strength. This requires a long period of physiotherapy in addition to the surgery.

– Surgery may be done Arthroscopically (keyhole) or Open, or a combination of the two, know as a Mini-repair.
– Some tears are too large to repair and are known as ‘Massive Cuff Tears’

Click here to access more through Shoulderdoc.co.uk

Rotator Cuff Repair

A complete rotator cuff tear will not heal. Complete ruptures usually require surgery if your goal is to return your shoulder to optimal function.

A rotator cuff repair involves stitching the torn tendon back onto its attachment to the arm bone (humerus) – see bleow.
This may be performed either through keyhole surgery Arthroscopy or open surgery, using sutures and bone anchors .

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