Rotator Cuff Tear

Rotator CuffThe rotator cuff is a group of 4 tendons that envelopes the shoulder joint and help to move the shoulder. The tendons are called supraspinatus, infraspinatus, teres minor and subscapularis. They provide rotation, elevate the arm, and give stability to the shoulder joint.

A rotator cuff tear occurs when one of the tendons is torn from the bone from overuse or injury – more than one tendon can be involved. Pain, loss of motion, and weakness may occur when one (or more) of the rotator cuff tendons tears. The tendons generally tear off at their insertion (attachment) onto the humeral head.

There are two types of rotator cuff tears:

  • A partial tear occurs when a tear does not completely sever the attachments to the bone.
  • A complete, full thickness tear means that the tear goes all the way through the tendon. It may be as small as a pinpoint, or the tear may involve the entire tendon. With complete tears, the tendon has come off (detached) from where it was attached to the bone.

Cause

Rotator cuff tears may occur in two ways:

  • A sudden acute tear may happen when the patient fall on his arm while it is stretched out. Or it can occur after a sudden, jerking motion when the patient try to lift something heavy.
  • A chronic tear of the rotator cuff tendon occurs slowly over time. It is more likely when the patient have chronic tendonitis or impingement syndrome. At some point, the tendon wears down and tears.

Signs & Symptoms

The symptoms of a rotator cuff tear includes pain in the shoulder and deltoid muscle region with movements of the arm above the level of the shoulder. Many patients experience pain at night and they cannot sleep on the side of the shoulder with the tendon tear.

When the tendon tear becomes massive, the patient may even have difficulties lifting the arm upwards. Some patients may even mistake their problem to be from a stroke.

Rotator Cuff Tear MRI

MRI showing a Tear in the Supraspinatus Tendon

Diagnosis

A physical examination may reveal tenderness over the shoulder. Pain may occur when the shoulder is raised overhead. There is usually weakness of the shoulder when it is placed in certain positions.

X-rays of the shoulder may show a bone spur or change in the position of the shoulder.

Other tests:

  • An ultrasound test uses sound waves to create an image of the shoulder joint. It can show a tear in the rotator cuff.
  • MRI of the shoulder may show swelling or a tear in the rotator cuff.
  • With a joint x-ray (arthrogram), contrast material (dye) is injected into the shoulder joint. Then an x-ray, CT scan, or MRI scan is used to take a picture of it. Contrast is usually used when a small rotator cuff tear is suspected.

Treatment

Rest and physical therapy may help with a partial tear if the patient do not normally place a lot of demand on the shoulder.

Surgery to repair the tendon may be needed if the rotator cuff has a complete tear. Surgery may also be needed if the symptoms do not get better with other treatment. Most of the time, arthroscopic surgery can be used. Large tears may need open surgery (surgery with a larger incision) to repair the torn tendon.

Surgery

Three common techniques are used to repair a rotator cuff tear:

  • During open repair, a surgical incision is made and a large muscle (the deltoid) is gently moved out the way to do the surgery. Open repair is done for large or more complex tears.
  • During arthroscopy, the arthroscope is inserted through small incision. The scope is connected to a video monitor. This allows the surgeon to view the inside of the shoulder. One to three additional small incisions are made to allow other instruments to be inserted.
  • During mini-open repair, any damaged tissue or bone spurs are removed or repaired using an arthroscope. Then during the open part of the surgery, a 2- to 3-inch incision is made to repair the rotator cuff.

To repair the rotator cuff:

  • The tendons are re-attached to the bone.
  • Small rivets (called suture anchors) are often used to help attach the tendon to the bone. The suture anchors can be made of metal or material that dissolves over time, and do not need to be removed.
  • Sutures (stitches) are attached to the anchors, which tie the tendon back to the bone.

At the end of the surgery, the incisions are closed, and a dressing is applied. If arthroscopy was performed, most surgeons take pictures of the procedure from the video monitor to show you what they found and the repairs that were made.

Recovery can take 4 to 6 months, depending on the size of the tear and other factors. And, patient have to wear a sling for 4 to 6 weeks after surgery. Pain is usually managed with medication.

rotator-cuff-tear-assessment

Insertion of Suture Anchor

Passing Suture Through Torn Cuff

Repairing Back to Bone

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