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A rotator cuff tear is a damage to the muscles that make up the rotator cuff. It is usually caused by repetitive or forceful actions like overhead swinging, and it leads to dull and deep-seated aches within the shoulder joint. It is most common in individuals who perform a lot of overhead action, although it can also be caused by trauma.
The rotator cuff is the name given to a group of muscles around the shoulder complex.
NB: The shoulder complex is different from the shoulder joint. The shoulder joint consists of the Humerus and scapula, coming together in a ball and socket connection. The shoulder complex, however, refers to all the other joint associations around the shoulder joint. Other joints that form the shoulder complex include:
The muscles of the rotator cuff are also referred to the SITS muscles because of the first letter of their names. They are
These four muscles’ tendons merge to form one big tendon. This is what is known as the rotator cuff tendon. The muscles perform several actions that contribute to the overall function of the shoulder joint. They assist in several activities from shrugging to moving the arm forward and bringing it backward. They are also primary movers, initiating movements.
A rotator cuff tear, as the name implies, refers to a tear in the tendon of the rotator cuff. Note that it refers to a tear in the tendon, and not the muscle itself. While tears in the muscle may occur, they are often very rare.
Rotator cuff tendinitis, on the other hand, is also called rotator cuff tendinopathy. The term tendinitis strictly refers to the inflammation of the tendon. However it is often used to describe the damage of the rotator cuff tendon. These two terms are often used interchangeably. They are both referred to as rotator cuff tears through the rest of this text.
Rotator cuff tears are caused by repeated overhead actions, like those involved with several careers like tennis and carpentry. This repeated action causes wear and tear of the tendons of the rotator cuff. It may also cause inflammation of the joint space. The condition can also be caused by trauma, although this is not as common as repeated use.
According to orthoinfo, about 2 million people suffer from rotator cuff tears every year in the United States. This means that it affects roughly 0.5% of the population. Another way to look at this is that it affects at least five in every one thousand people.
Because the tears are mostly caused by wear and tear, older people are, particularly at risk. Individuals over 40 years of are more disposed to getting rotator cuff tears than those under 40. An estimate asserts that between 15% to 30% of people over the age of 70 have some forms of rotator cuff tears.
Athletes prone to overusing their shoulders like tennis players, base ball pitchers, as well as individuals in other occupations like painting and carpentry all have higher risks. Additionally, trauma (like a fall) can also cause the condition in younger individuals.
Yet another risk factor of the condition is shoulder arthritis. Arthritis is a condition characterised by wear and tear of the joint mechanisms. It weakens the joint and limits its range of motion. Individuals with arthritis are also likely to develop shoulder instabilities, muscle weakness, and osteophytes. All of these put more stress on the rotator cuff and makes it more likely to tear.
All patients who experience rotator cuff tears have symptoms like pain, weakness, and loss of range of motion in the affected shoulder. These signs are often used in the diagnosis of the condition, as they can help to tell them apart from other related conditions like arthritis immediately.
Pain always accompanies rotator cuff injures. In fact it is what prompts the individual to seek medical attention. Depending on the severity of the tear, the pain can be a mild to deep burning ache in the shoulder. The pain is usually aggravated by actions that involve taking the arm overhead (like in combing the hair and reaching for the back.)
This symptom mimics the one in osteoarthritis. Patients with rotator cuff tears often experience stiffness in their shoulder joints. This stiffness is usually more evident in the mornings, right after they get out of bed.
The muscle weakness in rotator cuff tears is a secondary effect of the pain involved. Since the individual finds raising the arm painful, they normally avoid the motion and focus more on the other shoulder. Over time, the muscles of the shoulder begin to atrophy from lack of use. This then results in muscle weakness. Immediate onset of muscle weakness may also develop at the joint as a direct result of the tears.
This is one of the hallmarks of this condition. The injury prevents the affected individual from moving the shoulder through a certain range. The more severe the condition, the more the loss of range of motion. However, this limitation is caused because of the tear, which means that during the examination, the shoulder can still be moved through the joint’s full range.
The affected shoulder may be very painful to touch, especially if the injury is recent. There may also be some swelling in the area.
Rotator cuff tears are diagnosed using a combination of the history taking, physical examination, and a review of the symptoms.
This is usually to identify the root of the injury. As mentioned earlier, individuals in certain careers are likely to develop the condition.
Tests like the lift-off test are carried out to try to elicit the pain and rule out other possibilities like anterior instability of the shoulder joint.
The symptoms mentioned above, in combination with a complete history and physical examination, are usually enough to diagnose a rotator cuff injury. However, imaging tests like MRIs may be conducted to confirm the diagnosis further, or take a closer look in situations where the physical tests don’t give conclusive results. Because this condition affects muscles and tendons, X-rays are not useful. However, they can detect other bone-related anomalies like osteophytes
The shoulder joint can be braced to limit its movement, and thus prevent the progression of the condition. However, the brace is only applied for a short amount of time because bracing for prolonged periods can lead to more complications.
Ultrasound therapy is effective in some patients, and it can heal and reduce the pain around the rotator cuff muscles.
Exercises are often prescribed to keep the shoulder joint mobile, as limited use can lead to atrophy and other undesired results. Exercise can also be used to manage pain in the area.
For individuals who are in occupations that have a high risk of rotator cuff tears, they are advised to discontinue the actions for some time, giving the tendons time to heal. Depending on the severity, a little caution may be all that’s necessary. Ergonomic adjustments, like changing the positioning of keyboards and items at work, may also be made.
Surgery can also be performed to repair the rotator cuff in situations where the symptoms have not responded to other non-operative measures. They are also considered in full-thickness rotator cuff injuries. However, rotator cuff surgery is elective, and the patient can decide not to have one.
Orthoinfo. Rotator Cuff Tears: Surgical Treatment Options. American Association of Orthopaedic Surgeons. Last reviewed May 2011. Accessed November 3, 2014. http://www.orthoinfo.org/topic.cfm?topic=A00406
Templehof S, Rupp S, Seil R. Age-related prevalence of rotator cuff tears in asymptomatic shoulders. J Shoulder Elbow Surg.1999; 8:296–299.)
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