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Torn Rotator Cuff Injury

Torn Rotator Cuff Injury

A torn rotator cuff is one of the most common causes of shoulder injury today. It hampers daily activities, thus can be quite debilitating. Here are some of the causes, symptoms and treatment measures of this shoulder injury.
Rita Putatunda
Last Updated: Apr 11, 2018
The shoulder joint is an incredibly complex creation, comprising tendons, ligaments, muscles and bones, all working together to give your arm the kind of range of motion it has. The only drawback to this wide range of motion is the lack of stability, which is why the shoulder joint is susceptible to injury. Basically, the shoulder comprises 3 bones; clavicle (collarbone), the humerus (upper arm) and the scapula (shoulder blade).
Then there are 4 muscles in the shoulder joint, known as the subscapularis, the teres minor, the infraspinatus, and the supraspinatus muscle. Together, these four muscles form a cuff-like structure on top of the humerus bone, which is why they are called the cuff muscles.

These muscles are attached to the surrounding bones, with the help of four tendons. The function of the rotator cuff is to hold the arm onto the shoulder blade, thereby keeping it in place. It's also responsible for the rotating movement of the shoulder joint.
Rotator Cuff Injury or Tear
When the muscles of the rotator cuff contract, they apply tension on the tendons, which then contract and bring about movement of the shoulder joint. However, when excessive force is applied on the muscles and tendons, they may give way and develop a tear. Supraspinatus and infraspinatus tendons of the rotator cuff, are the ones more prone to injuries and tears.
Torn rotator cuff muscle
Causes of Rotary Cuff Tears
Most rotary cuff injuries are caused by two main reasons. One being due to wear and tear, over a long period of time, and the other being sudden falls. The tear usually occurs at or near the tendon.
Wear and Tear
People mostly associate rotator cuff tears to athletes, however, this tear is mainly seen to take place in the elderly. Repetitive stress to the muscles and tendons in the shoulder joint, due to years and decades of lifting, pushing, pulling, etc. plays a major role in causing their weakening and tearing. This is mainly visible in construction workers, and all those involved in jobs that are physically demanding.
Sudden Fall
Falling on an outstretched arm, or lifting something heavy that puts too much stress on the shoulder joint, can result in a rotator cuff tear. If force is applied on the arm when it is in an awkward or unusual position, a tear can occur. Jerking motions can also cause this kind of tear. This is mainly seen in athletes, sports professionals, etc.
Symptoms of Torn Rotary Cuff Injury
Minor tears will not spearhead any kind of symptoms, and if they do it will be mild pain in the shoulder regions. However,
Pain is felt in the shoulder region, when a tear occurs. However, the extent of pain experienced, will depend on the severity of the tear. Some may experience a tearing feeling in their shoulder, along with excruciating pain. Pain worsens at night, while sleeping. Moreover, one also cannot sleep on the side of the injured shoulder due to the extreme pain.

It is observed that the injury caused suddenly is the one which is very painful. On the other hand, a tear that has been caused over a long period of time, will have mild pain, but will be accompanied by weakness in the arm. Depending on the actual condition, popping and cracking sound will be observed.
Shoulder Weakness
Most patients complain of shoulder weakness. The weakness caused by the tear usually manifests itself by loss of movement, such as the inability to lift the arm overhead, reach behind for something, sleep on the troubled side, or to extend it to the front or side. This may be because of pain or muscle spasms. Usually, the larger the tear, the more difficult it is to move the arm, as well as the injured area. In some cases, there is a crackling sound heard, when the affected hand is moved in a particular position. If the arm is not used for an extended period, stiffness in the joint will be observed.
Treating a Rotator Cuff Tear
With rotator cuff injuries, minor tears do not heal on their own, and require medical intervention. If left alone, they can develop into bigger tears.
Non-surgical Treatment Measures
Ice and Rest
It is important to apply an ice pack on the injured area as soon as possible. Ice compression wraps are placed in hospitals to reduce the swelling. The injured arm should also be given rest, which means not performing tasks that aggravate the pain. This will help prevent further damage. Immobilizing the shoulder and arm completely is not advised, because it can cause a frozen shoulder. Anti-inflammatory drugs may also be given to reduce pain and swelling.
Heat Application
Once this procedure has been carried out, say for about 48-72 hours; the next thing that can be done is to increase the blood supply to the rotary cuff area, so that it gets the nutrients and oxygen it requires to heal. The best way to do that is to apply heat. Heat, in fact, is one of the best ways to increase blood flow to most parts of the body. You can use heat lamps for this, or perhaps a heat-based cream.
The next method of treating a shoulder injury is to massage the area. A massage not only increases the blood flow into the affected area, but can also help in reducing the scar tissue, usually associated with tendon and muscle tears and strains.
Simple Exercises
Highlighted bones of woman at physiotherapist
And finally, it is important not to stop moving the rotator cuff. Gently moving the affected part is another way to keep the area supplied with blood. Of course, if it hurts, you will need to limit the range of motion, but it is important not to keep the area completely still. The physical therapist will teach simple exercises that can be carried out, without applying unnecessary strain on the shoulder joint.
When does an Injured Rotator Cuff Need Surgery?
Deciding on when a torn rotator cuff will need surgical intervention will be dependent on various factors, such as:
➟ Response to treatment: If other forms of non-surgical treatments prove to be ineffective even after several months, a surgery is recommended.
➟ Extent of symptoms: People who experience incessant pain, or find it difficult to carry out everyday activities like lifting objects in the house, getting dressed, or experience pain during the night so that sleep is interfered with, will be advised to undergo a surgery.
➟ Type of rotator cuff tear: If the tear is large, the muscle may be weakened irreversibly. This kind of tear can be repaired only by surgery.
Types of Surgeries Performed
There are several types of surgery available to treat a rotator cuff tear. Three of the procedures commonly used are:

Open surgical procedure: Wherein a 6-10 cm long incision is made to repair the torn rotary cuff. The advantage of this method is that the tendons are seen easily, but due to the extent of the incision, recovery can often be painful and long.

Miniature open surgical procedure: In this surgical method a 3-4 cm incision is made and the rotary cuff is viewed through an arthroscope to clear out bone spurs or damaged tissue. Since the incision is small, the recovery is faster.

Arthroscopic surgical procedure: Here, tiny incisions are made through which an arthroscope with a small camera is inserted, and the repair is carried out by the surgeon while he/she views the process on a TV monitor. This is a relatively new procedure for treating torn rotator cuffs, and not all kinds of injuries can be treated by this method.
Before prescribing any of the surgeries, the patient will be advised X-rays or MRI to judge the exact nature of the condition. If with non-surgical treatment the condition can be treated, then the patient will be prescribed non-surgical methods only. Moreover, non-surgical methods of treatment are also advised to patients with major rotator cuff tears, that cannot be repaired even by surgery. The specialist will be the best person to advise the patient for or against any of the surgical procedures.
Disclaimer: The information provided in this article is solely for educating the reader. It is not intended to be a substitute for the advice of a medical expert.