Rotator Cuff Tears

What Is A Rotator Cuff Tear?

The bone of the upper arm (or the humerus) is positioned relatively loosely on the shoulder bone (the scapula). The reason for this is to allow the arm a full range of motion (i.e. upward and downward motion, flexing, and near total rotation). The shoulder joint also includes tendons and muscles, several of which make up the rotator cuff. The rotator cuff facilitates arm movements, particularly those involved in the lifting and rotation of the arm. Another main function of the rotator cuff is to maintain the stability of the shoulder joint, keeping the humerus firmly in place within the shoulder socket.

The tendons and muscles within the rotator cuff are susceptible to damage and injury. This may be due to their position relative to the scapula, where they may incur tearing by simple mechanical wear from movement against this bone. This condition is known as a rotator cuff tear.

The symptoms of rotator cuff tears include:

• Pain that is dull and throbbing, or intense and sharp, depending on the severity of the tear and its onset
• Increased stiffness or restricted movement, especially when attempting arm motions associated with the tear
• An inability to sleep or lie on the affected shoulder
• Increased weakness in the affected arm

Causes of Rotator Cuff Tears

Tears in the rotator cuff may develop gradually over time, also known as chronic rotator cuff tears. Tearing of these tendons may also happen more abruptly, in response to sudden or violent actions, such as:

• Falling on a shoulder or attempting to take the force of a fall with one arm
• Sudden swinging or lifting of the arm, which may result from poor technique or accidents in the course of athletic activity

These injuries are referred to as acute tears. Most rotator cuff tearing occurs as a result of upward or outward motion of the arm. The risk of these injuries tends to increase in proportion to the frequency of these motions. Professions or occupations in which lifting, throwing, or arm rotation is practiced or performed routinely are commonly linked to an increased risk of rotator cuff tears.

These professions include:

• Painters, carpenters, and other members of the construction or home maintenance industry
• Athletes, particularly shot-putters and swimmers
• Professional sportspeople, particularly those who play sports such as American football, tennis, and baseball

Rotator cuff tendon tears fall into two main categories: partial and full-thickness. Full-thickness tears involve the complete ripping of a tendon in two. In the case of partial tears, some of the tendon is still intact, while the rest has come apart. Partial tears may also be subdivided into those in which less than 50% of the tendon is torn, and those in which 50% or more is worn through. Severe rotator cuff tears may involve more than one tendon.

These tears are associated with many risk factors, including:

• Age: Chronic tears may form over many years in response to cumulative repetitive motion or age-related degeneration of the tissue that makes up a rotator cuff tendon.
• Repetitive stress: The tendons of the rotator cuff may become torn as a result of the overuse of the shoulder joint
• Arthritis: This is a condition that affects bone, cartilage, and other tissues of a joint. It is associated with the release of inflammatory molecules, which may damage surrounding tissues, including the tendons making up the rotator cuff.

Treatments for Rotator Cuff Tears

Mild rotator cuff tears, or tears that are diagnosed early on, can be managed with other options such as physiotherapy. This is a program of controlled exercises and musculoskeletal treatments designed to reduce or compensate for the excessive arm or shoulder motions that may be responsible for rotator cuff wear and tear.

Another effective treatment for a rotator cuff tear is an arthroscopic repair of the injury. These are procedures developed to repair tears in the relevant tendon(s) while posing minimal surgical invasion and damage. An arthroscopic repair can address moderate to severe rotator cuff damage.

Severe or very advanced rotator cuff tears require more extensive surgery. An example is total shoulder replacement, which is often indicated for shoulder joint degeneration caused by arthritis. This often involves the removal of the head of the humerus or surfaces of the scapula with which it interacts, and their replacement with artificial prostheses. Alternatively, the parts of these bones that are absent due to the effects of arthritis may be replaced with medical-grade materials or prostheses. Shoulder replacement may result in effective treatment for rotator cuff tear and the restoration of upper arm movement.

Conclusion

The rotator cuff is located around the head of the humerus, forming a short sleeve-like structure that connects it to the muscles of the shoulder. It is made up of tendons that may become worn through or torn. These rotator cuff tears can be the result of mechanical damage or overuse or excessively vigorous arm movements. People involved in certain occupations or professional sporting activities are at an increased risk of rotator cuff tears. Rotator cuff tears can cause considerable pain and loss of normal arm function. A minimally-invasive surgery may be the most effective treatment for a rotator cuff tear.

References

1. Freygant M, Dziurzynska-Bialek E, Guz W, et al. Magnetic resonance imaging of rotator cuff tears in shoulder impingement syndrome. Polish journal of radiology / Polish Medical Society of Radiology. 2014;79:391-397.
2. Nho SJ, Yadav H, Shindle MK, Macgillivray JD. Rotator cuff degeneration: etiology and pathogenesis. The American journal of sports medicine. 2008;36(5):987-993.
3. Economopoulos KJ, Brockmeier SF. Rotator cuff tears in overhead athletes. Clinics in sports medicine. 2012;31(4):675-692.
4. Basar S, Kanatli U, Citaker S, Bolukbasi S. Does presence of anterior greater tuberosity cysts change the function in patients with chronic rotator cuff tear? Eklem hastaliklari ve cerrahisi = Joint diseases & related surgery. 2014;25(3):141-147.
5. Citlak A, Akgun U, Bulut T, Aslan C, Mete BD, Sener M. Subacromial osteochondroma: A rare cause of impingement syndrome. International journal of surgery case reports. 2014;6c:126-128.
6. Kim SJ, Jung M, Lee JH, Kim C, Chun YM. Arthroscopic repair of anterosuperior rotator cuff tears: in-continuity technique vs. Disruption of subscapularis-supraspinatus tear margin: comparison of clinical outcomes and structural integrity between the two techniques. The Journal of bone and joint surgery. American volume. 2014;96(24):2056-2061.
7. Musil D, Sadovsky P. [Massive tears of the rotator cuff–comparison of mini-open and arthroscopic techniques. Part 2. Arthroscopic repair]. Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca. 2007;74(5):318-325.
8. Diaz-Borjon E, Yamakado K, Pinilla R, Keith P, Worland RL. Shoulder replacement in end-stage rotator cuff tear arthropathy: 5- to 11-year follow-up analysis of the bi-polar shoulder prosthesis. Journal of surgical orthopaedic advances. 2007;16(3):123-130.
9. Moosmayer S, Lund G, Seljom US, et al. Tendon repair compared with physiotherapy in the treatment of rotator cuff tears: a randomized controlled study in 103 cases with a five-year follow-up. The Journal of bone and joint surgery. American volume. 2014;96(18):1504-1514.