Rotator Cuff Tear
Age plays an important role in the development of rotator cuff tears. As we age, so does the rotator cuff, and weakening of the tendons increases the chances of a tear occurring. For this reason, tears are most common in adults over the age of 40. However, repeated use of the arms in the overhead position often accelerates weakening of the cuff. Individuals who perform common overhead activities, such as painters and sheetrock workers, frequently develop tendonitis, and this tendonitis may eventually progress to a complete tear in one of the rotator cuff tendons.
Tears are also common in certain athletes who use repetitive overhead motions, such as baseball pitchers, swimmers, and tennis players. In some cases, a tear can be sustained from a direct trauma - a fall from a bicycle, for example.
With a rotator cuff tear, you may experience pain primarily on top and in the front of your shoulder. Sometimes, pain may occur at the side of your shoulder, and it is usually worse with any activity that forces you to reach above the level of your shoulder. You may also experience weakness and stiffness, and it may be difficult to perform simple overhead activities like placing dishes in the cupboard. Some people with tears can't lift their arm to comb their hair. Stiffness may result from the inability to move your shoulder, and this stiffness may become progressive.
Often with a rotator cuff tear, bursitis (inflammation of the bursa, the small sac of fluid that surrounds the joint) will occur, which may cause a mild popping or crackling sensation in the shoulder. The tear itself may rub and cause this sensation. You may also have difficulty sleeping on the shoulder at night.
When a rotator cuff tear begins to interfere with normal activities, arthroscopic (minimally invasive) shoulder surgery may be necessary to restore your shoulder's full functional abilities.
A rotator cuff tear is typically confirmed by Diagnostic Ultrasound, Magnetic Resonance Imaging, or at the time of surgery. The thickness of the tear is extremely important. When the tendon does not tear all the way through it is called a partial thickness tear. However, when the tear goes completely through the tendon, it is termed a full thickness tear.
Full thickness rotator cuff tears will not heal by themselves. Additionally, studies have shown that rotator cuff tears get larger with time, and muscle atrophy that develops while the tendon is torn will become permanent (even after a successful repair). The larger the rotator cuff tear, the more shoulder function is lost.
Interestingly, some patients with rotator cuff tears do not have pain. It is thus possible to rehabilitate the shoulder to help eliminate pain. However, shoulder strength will not improve, and many patients will eventually develop pain.
Non-operative Treatment Options
Non-operative management of rotator cuff tears consists of a combination of activity modification, physical therapy, anti-inflammatory medications, and cortisone injections. Non-operative treatment has been shown to help in approximately 60 to 70% of patients. It is therefore often the initial recommendation for patients with minimal demands on their shoulders. Patients with higher demands on their shoulders should be strongly considered for early operative treatment. The best results of rotator cuff repairs are in patients treated early.
Surgical treatment of rotator cuff tears involves repairing the rotator cuff to the greater tuberosity where it normally inserts. This section of the greater tuberosity is called the “footprint” of the rotator cuff. Historically, this surgery was performed using a large incision over the shoulder, and often required a temporary detachment of a portion of the deltoid.
With the advancement of arthroscopic surgery, even the large rotator cuff tears are now being treated using an all-arthroscopic minimally-invasive technique. Most of the recent technological advancements in rotator cuff surgery have been directed at re-attaching the rotator cuff back to the anatomic position where it was torn, completely covering the “footprint” of the rotator cuff.
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