Rotator Cuff Tear & Repair

Introduction

Rotator cuff tears are a common source of shoulder pain. The rotator cuff consists of four shoulder muscles and their tendons. Tendons are strong fibers that connect our muscles to our bones. The shoulder muscles and tendons cover the upper end of our arm bone forming a cuff.
The risk of rotator cuff tears increases with age. The aging process can cause the tendons and muscles to degenerate and weaken. Rotator cuff tears can also result from sudden shoulder movements or overuse, for instance during sports, such as pitching in baseball or playing tennis, or falls.
The decision on how to treat rotator cuff tears is very individualized. Some rotator cuff tears can be treated with non-surgical methods. However, surgical procedures have become less invasive, resulting in good outcomes with improved recovery times.

Anatomy

Our shoulder is composed of three bones. The humerus is our upper arm bone. The clavicle is what we call our collarbone. The scapula is the shoulder blade that moves on our back. An edge of the scapula, called the acromion, forms the top of the shoulder. There are a total of four joints in our shoulder complex. The humerus and the scapula form the main shoulder joint, the glenohumeral joint.
The glenohumeral joint is not a true ball-in-socket joint like the hip, but it is similar in structure. The top of the humerus is round like a ball. It rotates in a shallow basin, called the glenoid, on the scapula. A group of ligaments, called the joint capsule, hold the ball of the humerus in position. Ligaments are strong tissues that provide stability. In other words, the joint capsule is responsible for holding our upper arm in place at our shoulder.
The four rotator cuff muscles form a single cuff of tendon that connects to the head of the humerus bone. The muscles allow the arm to rotate and move upward to the front, back, and side. A fluid-filled sac, called the subacromial bursa, lubricates the rotator cuff tendons allowing us to perform smooth and painless motions. We use the rotator cuff muscles to perform overhead motions, such as lifting up our arms to put on a shirt, comb our hair, or reach for an item on a top grocery shelf.
These motions are used repeatedly during sports, such as serving in tennis and passing in football. The rotator cuff also provides stability when our elbow flexes and as we lift objects.

Causes

Rotator cuff tears most frequently occur in the dominant arm but commonly occur in the non-dominant arm. The risk of rotator cuff damage increases with age. With age, the blood supply to our tendons decreases. This causes the tendons and muscles to degenerate, weaken, and become susceptible to tearing. Additionally, the tendon degenerates with age. The body’s ability to repair the tendon decreases over time because of the reduced blood supply.
Sometimes the aging process can cause bone spurs to grow on the scapula, particularly in the acromion area. Shoulder impingement syndrome occurs when bone spurs or bursa inflammation narrows the space that is available for the rotator cuff tendons. The tendons can tear as they rub across the bone spur, particularly when the arm is elevated. Inflamed tendon membranes may develop tendonitis, a painful condition. Shoulder impingement syndrome may even cause the rotator cuff tendons to detach from the top of the humerus.
Rotator cuff injuries can occur in younger people following a shoulder injury, such as a fracture or dislocation. Overuse or repetitive activity can also cause rotator cuff tears. This includes athletes that perform overhead movements during such sports as tennis, swimming, or baseball. This also includes workers who reach upwards repetitively during construction, painting, or stocking shelves.

Symptoms

The symptoms of a rotator cuff tear tend to appear gradually. You may first develop pain in the front part of your shoulder. Your pain may spread down the side of your arm. The pain may be mild at first and increase when you lift your arm or lower your arm from a fully raised position. Over time, the pain may be present when you rest and even wake you while you sleep. However, some rotator cuff tears are not painful at all.
Your shoulder may feel stiff. It may be difficult for you to move your arm. You may hear a crackling noise when you do so. Your arm may feel weak, especially when your lift or rotate it.
The symptoms of a rotator cuff tear caused by traumatic injury occur suddenly. You may feel a snap and sudden pain. Your arm will immediately feel weak, and you will have difficulty moving it.

Diagnosis

A doctor can evaluate your shoulder by performing a physical examination and viewing medical images. Your doctor will ask you about your symptoms and medical history. You will be asked to perform simple movements to help your doctor assess your muscle strength, joint motion, and shoulder stability.
Your physician will order X-rays to see the condition of the bones in your shoulder and to identify arthritis or bone spurs. A special dye may be used with the X-ray in a procedure called an Arthrogram. Sometimes a soft tissue injury does not show up on an X-ray. In this case, your doctor may order a Magnetic Resonance Imaging (MRI) scan or an ultrasound. A MRI scan will provide a very detailed view of your shoulder structure. It will help your doctor determine the location and type of your rotator cuff tear. An ultrasound uses sound waves to create an image when a device is gently placed on your skin. These tests do not hurt but require that you remain very still while a camera takes images.

Treatment

Many rotator cuff tears can be treated with non-surgical methods including rest and pain relief. Limiting overhead arm movements and wearing a sling may help to reduce symptoms. Over-the-counter medication or prescription medication may be used to reduce pain and swelling. If your symptoms do not improve significantly with these medications:
Ultrasound Guided Platelet rich plasma injection or Stem Cells injection for regeneration is promising (not FDA approved) but supported by multiple Studies.

Prevention

It may be helpful to exercise to maintain a strong, stable, and flexible shoulder. Avoiding repetitive overhead movements may help to prevent rotator cuff tears. Further, it is important to follow your doctor’s instructions for any weight lifting or motion restrictions.