Rotator Cuff Tear
Information About Rotator Cuff Tears
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The Rotator Cuff mainly consists of a group of tendons and four muscles that connect the upper arm bone (humerus) to the shoulder blade (scapula). Additionally, the tendons of the rotator cuff help stabilize the shoulder while the muscles facilitate rotation and movement of the shoulder.
Rotator cuff tears are the most common shoulder injury. The rotator cuff consists of the following muscles: teres minor, infraspinatus, supraspinatus and subscapularis. These four muscles originate in the shoulder blade (scapula) and are connected to the humerus bone by tendons. The four muscle/tendon components are perform the following functions:
- Supraspinatus: runs over the humeral head or ball joint of the shoulder and is responsible for abduction of the arm.
- Subscapularis: runs across the front of the humeral head and internally rotates the arm.
- Teres minor: runs across the back of the humeral head and externally rotates the arm.
- Infraspinatus: runs across the back of the humeral head and this muscle externally rotates the arm.
A rotator cuff tear occurs with one of the four tendons connecting one of the four muscles sustains either a partial tear or full thickness tear.
- Partial Tear: this type of tear results in some damaging of the tendon .
- Full Thickness Tear: Also known as a complete tear, this tear rips the soft tissue into two pieces.
Middle aged adults and older adults with preexisting shoulder problems are more likely to sustain rotator cuff tears. High impact injuries are typically required in order produce full-thickness tears to a healthy rotator cuff found in teens and young adults. The high impact trauma usually required occurs in slip and fall accidents and motor vehicle/car accidents. Younger individuals are more likely to suffer partial thickness rotator cuff tears. Older individuals on the other hand are prone to sustaining full thickness rotator cuff tears and multiple tendon tears.
Symptoms Of A Rotator Cuff Tear
Pain in shoulder when attempting to raise arm above your head;
- Weakness when lifting or rotating your arm;
- Trouble sleeping due to nigh-time pain. Unable to sleep on shoulder;
- Crackling sounds whenever moving shoulder; and/or
- A popping sound heard at the time of the tear.
Partial thickness rotator cuff tears have a good chance of healing without surgery. Physical therapy is an important form of treatment for partial thickness tears. Physical therapy helps regain lost mobility and strengthens the other muscles of the shoulder which will take pressure off the injured tendon allowing it time to heal.
Full thickness tears typically do not heal on their own. This is because the muscles continue to put pressure on the tendon causing the edges of the tendon tear to pull apart. There are a few options for surgical repair.
- Arthroscopic Repair: A minimally invasive procedure whereby the surgeon inserts a tiny camera into the shoulder joint. The images from the camera appear on a T.V. in the operating room. The surgeon is able to perform surgical repairs through a very small incision with the help of the video footage and a tiny set of surgical instruments.
- Mini-Open Repair: Relatively new technology allows the surgeon to perform repairs through an incision 3 to 5 centimeters long. This form of surgery allows the surgeon to view the shoulder tear directly instead of on the T.V. During this surgery the surgeon will rely on the arthroscopic camera to view, remove and repair other structures that are not visible through the 3 to 5 centimeter incision.
- Open Repair: This is the traditional form of surgery. The operation is performed through an incision several centimeters long. Open repair is usually performed when there is a large complex tear.
Surgical Repair And Considerations
Surgery could be considered if any of the following apply:
- Symptoms continue for 6 to 12 months.
- There is a large tear. Anything greater than 3 cm is considered a large tear.
- Extreme loss in shoulder strength and function.
- There is an acute injury. An acute injury is one that was caused by some form of trauma like a car accident, truck accident, motorcycle accident or slip and fall accident.
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