Rotator Cuff Tear

Rotator Cuff
The rotator cuff is the name for the tendons that surround the shoulder joint. The rotator cuff is important in allowing the shoulder to function through a wide range of motions. In part due to the rotator cuff, the shoulder joint can move and turn through a wider range than any other joint in the body. This motion of the shoulder joint allows us to perform an amazing variety of tasks with our arms.

Unfortunately, a rotator cuff tear is not an uncommon problem, and these injuries make many routine activities difficult and painful. The rotator cuff is part of this mechanism that, when healthy functions very well, but when injured can be a difficult and frustrating problem.

What is the rotator cuff?
The rotator cuff is a group of four muscles and their tendons that wraps around the front, back, and top of the shoulder joint. Together the rotator cuff muscles help guide the shoulder through many motions, and also lend stability to the joint. The ends of the rotator cuff muscles form tendons that attach to the arm bone (humerus). It is the tendinous portion of the rotator cuff that is usually involved in a rotator cuff tear.

What is a rotator cuff tear?
A rotator cuff tear occurs when there is an injury to one of the rotator cuff tendons. Rotator cuff tears occur in many shapes and sizes, but can be thought of as a hole in one of the tendons around the shoulder joint. Like most orthopedic conditions, the most common mechanisms of a rotator cuff tear are separated into 'repetitive use' and 'traumatic injuries.'

* Repetitive Use Injury
In repetitive use injuries to the rotator cuff, repeated activities cause damage to the rotator cuff tendons. Over time, the tendons wear thin and a rotator cuff tear can develop within the tendons. Patients with repetitive use injuries to the rotator cuff often have complaints of shoulder bursitis prior to developing a rotator cuff tear through the tendons.

* Traumatic Injuries
Traumatic injuries to the rotator cuff are seen after events such as falling on to an outstretched hand. The traumatic event can cause a rotator cuff tear by injuring the rotator cuff tendons. This mechanism is much less common than repetitive use injuries, but when a rotator cuff tear occurs in a patient younger than 60 years old it is usually a traumatic injury.

Who is most susceptible to a rotator cuff tear?
A rotator cuff tear is seen both in the young and old, but they are much more common in the older population. Usually in younger patients, there is either a traumatic injury, or the patient is demanding unusual use of their shoulder, as seen in professional athletes.

As people age, the muscle and tendon tissue of the rotator cuff loses some elasticity, becomes more susceptible to injuries, and is often damaged while performing everyday activities. This is the reason that rotator cuff tears are more commonly seen in older patients.

How common are rotator cuff tears?
Not every rotator cuff tear causes significant pain or disability. In fact, autopsy studies have shown rotator cuff tears in up to 70 of people over the age of 80 and 30 of the population under the age of 70. Clearly, all of the people with rotator cuff tears are not complaining of painful symptoms. However, in many individuals, a rotator cuff tear can cause significant disability, and prompt diagnosis and treatment can have a profound improvement in symptoms.
Provides immobilization for rotator cuff repairs, capusular shifts, Bankhart repairs, glenohumeral dislocations / subluxation and soft tissue repairs and strains. For use after initial anterior shoulder dislocation or post operatively when external rotation is desired.
Surgery is also considered in patients who have tried conservative treatment, and still have difficulty with their shoulder.

For more information on what factors are used to decide when rotator cuff surgery is necessary:

o When is rotator cuff surgery needed?

There are several surgical procedures that are possible for rotator cuff treatment. The three most common procedures are:

* Open Repair
Prior to the use of the arthroscope, all rotator cuffs were repaired by looking directly at the torn tendon, through an incision about 6-10 centimeters in length. The advantage is the rotator cuff tendons are easily seen by this method, but the incision is large, and the recovery can be longer and more painful.

* Mini-Open Repair
The mini-open method of repairing a rotator cuff involves both the use of an arthroscope, and a short incision to get access to torn tendon. By using the arthroscope, the surgeon can also look into the shoulder joint to clean out any damaged tissue or bone spurs. The incision is about 3-4 cm, and the recovery is somewhat less involved than the open cuff repair.

* Arthroscopic Repair
An arthroscopic repair is done with small incisions, and the repair is done by the surgeon looking through a small camera to watch his or her repair on a television monitor. This is a more recent development in treatment of rotator cuff tears, and not all types of tears can be treated by this method. Some advantages and disadvantages of this procedure are discussed in the article comparing arthroscopic rotator cuff repairs to open methods.

The surgery to perform the rotator cuff repair generally lasts about two hours.

How long is the recovery from rotator cuff repair surgery?
This will depend on several factors, including your level of strength before the operation and the severity of the rotator cuff tear. Some period of immobilization of the shoulder joint is needed to protect the newly placed sutures from being disrupted. After one to two weeks, physical therapy begins. Initially, the therapy is gentle so as not to affect the rotator cuff repair. After four to six weeks, more active lifting with the arm begins. Several months after the rotator cuff repair, physical therapy will become more intense in an effort to strengthen the rotator cuff muscles. Complete recovery usually requires at least four to six months.