Rotator Cuff Tear

The rotator cuff is a set of four muscles ā€“ supraspinatus, infraspinatus, subscapularis, and teres minor that come from the scapula (shoulder blade) ā€“ and their tendons that keep your humerus (upper arm bone) attached to the shoulder socket. It is responsible for keeping the entire arm stable and mobile. Rotator cuffs get a lot of everyday use. The likelihood of rotator cuff tears will depend on a combination of factors like your age, occupation, daily activities, sports activities, or a traumatic injury.

There are two types of rotator cuff tears which are: partial and complete. A partial tear renders a damaged tendon that protects the top of the shoulder. A complete tear renders a whole tendon torn or pulled from the bone.

A rotator cuff tear develops more over time than through a sudden injury. Usually, it occurs in people who perform constant overhead motions or activities in their jobs such as carpenters, painters, basketball players, etc. The normal wear and tear or repetitive arm motions develop. The risk of developing these diseases increases with age.

However, it can also develop as a result of a single event. It is especially common to happen in an instant in high-impact sports such as football, or accidents such as falling on oneā€™s arm.  Dislocating a shoulder can also result in a rotator cuff tear. In these cases, most of the time immediate medical attention is required, since it may require an immediate surgical operation.

The Most Common Causes of Rotator Cuff Tears

The most common root causes of rotator cuff tears are injury (acute) and degeneration. A rotator cuff tear can be a product of both of these causes. In many cases, you will feel a snapping sensation when the tendons tear. There are many causes for a torn cuff. The most common causes are:

A Bad Fall

When you fall, you will likely use one or both arms to brace yourself for the coming impact. You may hear a snapping sound at the exact time of injury. If this results in a combination of shoulder pain, weakness, and restricted mobility, it can be simple to detect if the fall has caused a rotator cuff tear. If it is caught early, you can minimize the damage and shorten your recovery time.

Occupational Overuse

Youā€™ll find people in specific lines of work are more susceptible to rotator cuff tears than your average human. These professions include painters, carpenters, and delivery men. Painters and carpenters both perform tasks that require the overhead extension of their arm for hours on end.

Athletic Activity

All kinds of sports can lead to your arm being hyper-rotated. In sports like football, judo, wrestling, baseball, and gymnastics, rotator cuff tears are not uncommon.

Automobile Accident

Many automobile accidents lead to torn rotator cuffs due to the fact that your shoulder area is lined up with the steering wheel. A sudden impact of your shoulder with the steering wheel could easily tear your rotator cuff.

A Pulled Shoulder

Pulled shoulder muscles can happen at any time if your limbs are under too much stress load. Handling excessive loads can do more than just pull your shoulder muscles. This may also end up tearing your rotator cuff.

Excessive Weight Lifting

Being reckless with weights and pushing one’s limits can cause rotator cuff tears. When extreme weight is placed on your rotator cuff, it is more likely to result in a tear. If you notice a snapping sensation while weightlifting or even just carrying something heavy, you could have a torn cuff.

Age

Age is a very common cause of rotator cuff tears. When you get older, your muscles go through a natural degeneration process. If you do not exercise regularly as you get older, you will have a higher risk of a rotary cuff tear.

Poor Nutrition

Poor nutrition is often underestimated as a contributor to a torn muscle as once again, it prevents the usual healing that is required in order for the muscle to grow back adequately.

Rotator Cuff Tears Red Flags & Signs

A very good indicator that a painful, weak shoulder has a rotator cuff tear, is the inability to sleep at night due to the pain. This often means that surgery should be a consideration for treatment.

One simple well-known test to check for a torn rotator cuff is the ā€œdrop-armā€ test. This test is performed by passively abducting the patient’s shoulder, then observing as the patient slowly lowers the arm to the waist. If the arm drops involuntarily to the side of the patient, it indicates a rotator cuff tear.

Be aware of red flags that indicate the need for urgent treatment and a referral to secondary care, like an orthopedic doctor. A history of trauma to the shoulder can be a red flag ā€“ particularly if the pain and weakness inhibit all passive and active movements.

Watch for systemic symptoms such as fever, night sweats, abnormalities in shoulder joints. Localized mass or swelling in the shoulder and severe restriction of movement are also red flags. Again, the inability to sleep well at night can mean that the rotator cuff is severely torn and more robust treatment, even surgery may be necessary.

What Are The Symptoms?

Symptoms from a rotator cuff are due to the inflammation from the strain, which causes swelling, leading to localized pain and decreased mobility. Since the rotator cuff is hidden well below, the swelling is not so easily felt. However, the swelling is enough to fill up the already small space that exists in the shoulder joints to reduce mobility of the shoulder and shoots pain with movement.

The following symptoms that may be felt with a rotator cuff tear:

  • Numbness in shoulder
  • Pain when lying on shoulder
  • Decreased mobility in shoulder
  • Arm weakness
  • Inability to lift arm high due to pain
  • Decreased mobility in the arm
  • Inability to lift things as one normally does
  • Clicking and popping in arm movements

Are Your Rotator Cuffs At Risk Of Tearing?

The following are risk factors that increase the chances of a rotator cuff development:

Age

Most causes for rotator cuffs are degeneration rather than injury. This means that it usually develops over a long period of time due to normal wear and tear. It is most common for people at the age of 40.

Work related strain

Jobs and sports that involve repetitive arm motion such as baseball pitchers have a higher risk of developing a rotator cuff. When constant lifting and overhead motion is involved, people are more prone to overuse tears

Genetics

If a family is involved with a medical history in rotators cuffs, then the risk is higher. There may be a genetic explanation as to rotator cuff injuries occurring more in certain families.

How To Protect Your Shoulder From a Rotator Cuff Tear

Rotator cuff tears are more common as one grows older. However, the chances increase with other risk factors such as sports activity or job activities that involve repetitive overhead motions that contribute to the constant wear and tear in the rotator cuff. The following are examples of prevention methods that can be done to prevent the development of a rotating cuff tear:

Exercise

Stretching before doing any strenuous activity helps the body warm-up. Otherwise, the rotator cuff can easily get inflamed. Strengthening the rotator cuff through low resistance exercises also helps avoid this injury. These strengthening exercises are essential to provide the shoulder a balanced strength. The key is to keep the shoulder strong and flexible along with the other muscles in the shoulder.

Be physically aware

Once soreness is felt in the shoulders after performing a certain activity, donā€™t simply ignore it. Further exercises or doing other activities might only worsen the condition of a rotator cuff tear. If the conditions continue to worsen, consult a physician immediately.

Proper posture and lifting

Most of the time during work, arms are stretched in front of the body. This posture ruins the shoulder balance, which eventually leads to a rotator cuff tear. Some work also requires plenty of lifting, if improperly done can also lead to a rotator cuff tear. Hence, proper lifting techniques must be learned and practiced.

How Do We Treat Rotator Cuff Tears in Florida?

In Florida, designing the correct treatment for rotator cuff tears is unique to each patient. It will depend on the patient’s symptoms, age, medical history, current health, and other factors. To get the best treatment, you will need to consult with a specialist, like an orthopedic doctor.

To determine the extent of the tear and the injured cuff, your doctor will need to perform a range of mobility and pain tests involving your shoulder and arm. In addition, imaging tests like x-rays, magnetic resonance imaging, or ultrasound are necessary to complete the diagnosis.

As with all conditions, there are both conservative (non-surgical) and surgical treatment options. Most rotator cuff tears can be healed with the following non-surgical methods:

Surgical Treatment

Of course, there are options for repairing rotator cuff tears surgically. In recent years, less invasive procedures and surgical techniques for rotator cuff repair have been developed. The method of repair that is correct for the individual patient depends on several factors, among them, being your surgeon’s experience and intimacy with a particular procedure, your age, the size of your tear, particulars regarding the tendon tissue and bone.

The three most common procedures used for rotator cuff repair include traditional open repair, arthroscopic repair, and mini-open repair. All three repair methods have the goal of healing the rotary cuff tear, relieving pain, and improving strength so the patient can return to a normal healthy lifestyle.

The majority of surgical repairs can be performed on an outpatient basis and do not necessitate an overnight stay in the hospital. Consulting with your orthopedic surgeon will help you decide on the most appropriate procedure for you to reach your health goals.

Is Surgery Recommended?

As with most medical conditions, surgical options should be discussed and will likely only be considered if non-surgical treatments have been unsuccessful.

Rotator cuff repair surgery may be preferred if both of the following are true:

  1. The person’s pain or weakness limits their capacity to perform everyday activities, to be physically active, and to enjoy a good night’s sleep.
  2. Their symptoms have not improved after trying nonsurgical treatments, including a physical rehabilitation program unique to the individual needs of the patient.

Sudden rotator cuff tears, such as those resulting from a sports injury, fall, or automobile accident, are often best treated with early surgery. Although some types of rotary cuff tears, including very large tears, cannot be fixed, particularly if a person has had them for many years. Some surgical procedures are designed to help relieve pain by removing damaged tissue from the joint.

Rotator Cuff Repair Surgeries

In most cases, conservative treatment is enough to heal the rotator cuff tear. However, in severe conditions, surgery may be required such as a complete tear of the tendon from the bone.

Open Repair Surgery

This is the more traditional surgery performed to address rotator cuff tears. It is often done as well when the tear is quite large. It involves an incision about seven centimeters long. The incision is made over the shoulder and the surgeon opens a flap in the shoulder muscles to access the torn tendon. The surgeon either reattaches the tendon to the bone or does a tendon transfer.

A tendon transfer is performed when a tendon is severely damaged to be reattached. A tendon from a different location is used to repair the rotator cuff. Usually, the Latissimus dorsi tendon is used.

Two incisions are made: on the front of the shoulder and the other at the back. In the back, the surgeon detaches a part of the Latissimus dorsi tendon, attaches a suture (threadlike material used to reattach tendons) then reaches for it through the front incision then secures it in a new position. It is connected to the remaining rotator cuff tendons and bones.

All-Arthroscopic Repair

In an arthroscopic repair, the surgeon makes small incisions each about 1 cm. The surgeon then uses a tiny camera called an arthroscope to insert it in the shoulder joint. The arthroscope is a tiny fiber-optic camera that has a tiny lens, light source, and video camera.

The camera allows a visual on the television screen. This serves as a guide to the surgeon to perform the surgery and uses miniature surgical instruments. The surgical instruments are about 3 to 4 mm in diameter. This allows the surgeon to assess the severity and type of injury, and then take steps to fix it.

Using a special instrument called the suture passer, the suture is passed from side to side of the limb of the tear. Both ends of the tied suture are brought together, and this is repeated until the whole tear is repaired.

Suture anchors are then inserted using a long insertor. The sutures from the anchors are pulled and passed through the tendon. Both sutures are then tied sequentially, and this process is repeated until the whole tear is repaired. This is an outpatient surgery and is more minimally invasive compared to Open Repair surgery.

Recovering After Surgery

The recovery period will depend on the kind of surgery the patient underwent, the severity of the damage, and a number of other factors unique to each patient. The recovery process may take only a little time for others while others may experience a longer period of recovery. ArthroscopicĀ surgery has a shorter recovery span compared to open repair surgery considering that fewer incisions were made in the shoulder.

After surgery, the surgeon and a therapist will provide the patient with specific instructions for exercise and other recovery methods. One should strictly follow these instructions. One may feel better already and will eagerly go back to work. However, one should always follow the physicianā€™s instructions otherwise it may not heal. The muscles around the arm may have suffered a loss of strength and must therefore be accompanied by sure and deliberate rehabilitation.

After the surgery, you may be given a shoulders sling. In most activities, one must wear with exceptions when bathing, dressing, and easy light activities.

Schedule A Rotator Cuff Tear Surgical Consultation

If you have suffered a serious rotator cuff tear and conservative treatment simply isn’t working, you may be a candidate for rotator cuff repair surgery. The surgeons at Florida Surgery Consultants will help diagnose the cause of your injury and develop a treatment plan tailored to your needs.

You can schedule your initial consultation today by calling us at (888) 411-6824. Appointments can also be scheduled online via our form on the right side of the page.Ā 

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