The rotator cuff is a group of muscles and tendons in the shoulder that help to stabilize and move the joint. There are four muscles in the rotator cuff: the Supraspinatus, Infraspinatus, Teres minor, and Subscapularis. These muscles connect the shoulder blade to the upper arm bone and work together to allow the arm to lift and rotate. The tendons of these muscles can become damaged or torn, leading to a rotator cuff tear.
Causes of Rotator Cuff Tear
Rotator cuff tears can occur for a variety of reasons, including:
Overuse: Repeated overhead movements, such as those used in sports like tennis, baseball, or swimming, can lead to rotator cuff tears over time.
Degeneration: As we get older, the tendons in the rotator cuff can become weakened and more prone to tears.
Trauma: A fall or other impact to the shoulder can cause a sudden rotator cuff tear. This is particularly important in patients over the age of 40 with a shoulder dislocation.
Genetics: Some people may be born with weaker tendons that are more susceptible to tearing.
Symptoms of Rotator Cuff Tear
The symptoms of a rotator cuff tear can vary depending on the severity of the injury, but may include:
Pain: The most common symptom of a rotator cuff tear is pain in the shoulder, especially when reaching overhead or performing daily activities.
Weakness: You may experience weakness or difficulty lifting objects or performing tasks with the affected arm.
Clicking or popping: You may feel a clicking or popping sensation when moving the shoulder joint.
Limited range of motion: You may have difficulty moving your arm in certain directions or have a limited range of motion in the shoulder joint.
Swelling or tenderness: You may notice swelling or tenderness around the shoulder joint.
If you experience any of these symptoms, it's important to see a doctor for a proper diagnosis and treatment.
Diagnosis of Rotator Cuff Tear
If you suspect that you have a rotator cuff tear, your doctor will perform a physical examination, which may include testing your range of motion and strength in the affected arm in addition to specialised clinical tests. They may also order imaging tests, such as an X-ray, ultrasound, or MRI.
An X-ray can help rule out other conditions that may be causing your symptoms, such as a broken bone. However, it cannot detect a rotator cuff tear.
An ultrasound is a non-invasive, painless test that uses high-frequency sound waves to create images of the shoulder. It is often used as a first-line imaging test for rotator cuff tears because it is relatively inexpensive and does not expose the patient to radiation. An ultrasound can show if there is a tear in the rotator cuff and can also help to determine the size and location of the tear.
An MRI provides a more detailed look at the shoulder joint and surrounding tissues. It uses a powerful magnet and radio waves to create images of the shoulder. An MRI is often used when a more detailed diagnosis is needed especially when surgery is considered.
Non-Surgical Treatments for Rotator Cuff Tear
In many cases, non-surgical treatments can be effective in treating rotator cuff tears. These treatments may include:
Rest: Resting the affected shoulder and avoiding activities that cause pain or discomfort can help to reduce inflammation and promote healing.
Ice and heat: Applying ice to the shoulder for 20 minutes at a time, several times a day, can help to reduce pain and inflammation. After a few days, heat may be applied to the shoulder to promote blood flow and healing.
Physical therapy: A physical therapist can help you to improve your range of motion and strengthen the muscles around your shoulder joint. They may also use techniques such as massage, strengthening exercises, stretching or acupuncture to help relieve pain and improve mobility.
Medications: Over-the-counter pain relievers, such as Paracetamol or Ibuprofen, can help to reduce pain and inflammation.
Corticosteroid injections: A corticosteroid is a powerful anti-inflammatory medication that can be injected directly into the affected area. The injection can be done in a doctor's office and is usually a quick and relatively painless procedure. Corticosteroid injections can provide significant relief from pain and inflammation, and may allow patients to resume normal activities without the need for surgery. Read this article from ACTIVATE and learn more about shoulder injections.
Surgical Treatment for Rotator Cuff Tear
If non-surgical treatments are not effective in relieving symptoms, surgery may be necessary. Surgery for rotator cuff tears may involve repairing the torn tendon or muscle, or removing damaged tissue.
The type of surgery recommended will depend on the size and location of the tear, as well as the patient's overall health and activity level.
After surgery, you will need to follow a rehabilitation program to help restore strength and mobility to your shoulder. This may include physical therapy, exercises, and other treatments.
What if a Rotator Cuff Tear is left untreated?
Untreated rotator cuff tears can lead to further damage, decreased mobility, and chronic pain in the shoulder. Without proper treatment, the tear may become larger and more difficult to repair, requiring more extensive surgery or even a full shoulder replacement. Additionally, untreated rotator cuff tears can lead to a condition called frozen shoulder, where the shoulder joint becomes stiff and difficult to move. Seeking medical attention as soon as possible is crucial for a proper diagnosis and effective treatment to prevent further damage and promote healing.
When to See a Doctor
If you experience any of the symptoms of a rotator cuff tear, it's important to see a doctor as soon as possible. Delaying treatment can lead to further damage and may require more extensive treatment in the future.
It's especially important to seek medical attention if you experience:
Severe pain or sudden weakness in the affected arm
Inability to lift objects or perform daily activities
Swelling, redness, or warmth around the shoulder joint
Numbness or tingling in the affected arm
Conclusion
Rotator cuff tear is a common shoulder condition that can cause significant pain and limited mobility in the shoulder. Seeking medical attention as soon as possible is crucial for a proper diagnosis and effective treatment.
Non-surgical treatments can be very effective in management of Rotator cuff tears. Surgery may be necessary for more severe cases. In addition to rest, physical therapy, and medication, corticosteroid injections can also be used as a treatment option to help relieve pain and inflammation in the shoulder joint. Remember to work closely with your doctor for effective treatment and prevent further damage.
About the Author: Dr. Mustafa Alnaib MBChB, MRCS, MSc, FEBOT is an orthopaedic surgeon, musculoskeletal doctor and Clinic Director at ACTIVATE Musculoskeletal Clinic in Kent.