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Rotator cuff tear

What is Rotator Cuff Tear?

Detachment or rupture of the rotator cuff muscle from the bone attachment is commonly called as rotator cuff tear.  The arm bone is coherently kept in the shoulder socket by the action of the muscles that form the rotator cuff. The function of the rotator cuff muscle is to lift and rotate the arm.  It covers the head of the arm bone(humerus) at the shoulder joint and helps to keep the arm bone concentrically articulated with the shoulder blade cup (Glenoid.  This also ensures that the shoulder is always well located in the joint. Rupture of the rotator cuff results in loss of normal function of the shoulder joint.

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What causes it?

The exact cause of the rotator cuff tear is yet to be identified.  It can occur as a result of trauma such as a fall.  In this the force involved  exceeds the strength of the tendon hence it ruptures.  This is the mechanism of tear in an athlete during a forceful throwing activity as part of the involved sports such as cricket, tennis etc.
The other more common mode of tear is due to degeneration.  Degeneration is the description given to the wearing of the tendon occurring gradually over a period of time due to the combination of various factors.  The common factors that result in degenerative tear are repetitive overhead activities, reducing blood supply to the tendon and also rubbing of tendon by the spur coming from acromion bone which is part of the shoulder blade bone.

What are the symptoms/effects?

The common presenting symptom is pain in the shoulder and  reduced ability or inability to lift the arm especially above the level of the head. This is particularly profound when carrying some weight in the hand.    The severity of the pain can increase to the level that sometimes it affects the sleep in the night and also sometimes one could also feel a painful creaking sensation while moving the shoulder joint.

How is it diagnosed?

The condition is diagnosed by thorough evaluation of the problem, examining the shoulder for specific clinical tests.  The clinical tests involve assessing the shoulder joint for individual muscle function, assessing neck movements and also examining the nerves and blood supply to the arm.  After a through assessment, some tests such as X ray, ultrasound scan or an MRI scan may be needed to confirm the diagnosis.  The tests that are carried out will give a guidance of how large is the tear and also to assess the quality of the muscle.  This will help in giving a guidance on the treatment plan.

What are the treatment options?

The initial treatment for this condition is to take adequate painkillers tablets.  This can help to alleviate some symptoms.    The function of the arm can partially be recovered by physiotherapy exercises.  But the torn muscle would not attach by itself, hence the function of the shoulder never reaches normal. 

Depending on the age, activity, general health and the type of tear an option to repair Rotator cuff repair by surgery can restore a satisfactory function. 

Continuing pain, significant weakness and loss of function in the shoulder are the reason why a rotator cuff tear needs repairing.  The tears can vary in size and some of the tears are massive and are not repairable.  In majority of the cases this repair is done by Arthroscopic  surgery. Some times the arthroscopy assisted open rotator cuff repair would be undertaken.