How to deal with Rotator Cuff Tear?

Our body is divided into different muscle groups for different bodily functions. The rotator cuff is one such group of muscles and tendons, surrounding the shoulder joint. It is responsible for keeping the head of your upper arm bone within the socket of your shoulder. A rotator cuff injury causes a dull ache in the shoulder. 

This is a group of four muscles and tendons. Their main function is to help you do heavy lifting and rotate your arms. So if there is a rip in the muscles it is called a rotator cuff tear. These rotator cuff tears are of three types.

• Partial tear: This is when one of the fours muscles of the rotator cuff is frayed or damaged. 
• Complete tear: This one is where the tendon is pulled off the bone.
• Degenerative tear: This happens over time when the muscle wears off. 

Rotator cuff injuries like these are quite common, especially in sports involving a lot of arm action, like baseball or tennis. It can also happen to people who have jobs that involve a lot of arm activity like cleaning windows. Over time with normal wear and tear also this can happen, especially if the same movement is repeated over and over or due to the impact of a fall. Let us understand the causes better. 

What are the causes of Rotator cuff tear?

These injuries are very common around us and once they happen the pain can bother you, especially at night. Unless treated properly, with every future hand action trauma it will be triggered again and the injury will then tend to worsen over time. These injuries are mainly caused by 

• progressive wear and tear of the tendon in the muscle set 
• repeated overhead activity of the arm
• prolonged sessions of heavy lifting 
• accidents or sudden fall on the respective muscle group

Based on the above causes here are the people who have the highest risk of having a rotator cuff tear: 

• People above the age of 60 years. Aging will make your muscles weak. A sudden heavy lifting can trigger the injury too. 
• Lack of blood supply or poor circulation can also cause this problem. Due to lack of blood small tears might appear over time which can be hard to repair. 
• Bone spurs or overgrowth of bone in the shoulder can happen with age, tearing the cuff tissues. 
• Occupations demanding repeated overhead arm action, for example: house painting, carpentry, etc. 
• Sports persons in games like tennis, rowing, cricket, weight-lifting and baseball. The tear can happen due to stress on the muscle group.  
• Those with a family history of rotator cuff tears are definitely more likely to get it. 

What are the symptoms of Rotator cuff tear? 

The most tell tale sign of a rotator cuff tear is a dull pain in the area of the muscles and tendon tissue. But it will also be accompanied with other symptoms. To summarise, these are: 

• Disturbed sleep
• Difficulty to reach your hand to your back
• Difficulty in combing your hair
• Difficulty wearing clothes by raising your arm 
• Overall weakness of the arm 
• Dull persistent pain deep in the shoulder

While some injuries don’t come with pain, if you are having discomfort in your shoulders, it is advisable to reach out to a physician and get it checked. If ignored, these problems will keep persisting leading to permanent loss of motion of the arm, frozen shoulder, arthritis or persistent weakness.  

How is a rotator cuff tear diagnosed?

Once you reach out to a doctor or sports injury specialist, they will feel the region and affected parts. Test your arms mobility and strength, as to whether you can lift your arm or not. Based on the physical assessment the doctor will prescribe one or more of these tests to form a clear picture:

• X-ray of the arm: A muscle tear is less likely to show in an x-ray, but this will help rule out any bone growth or arthritis. 
• Ultrasound: This will help understand the level of tissue damage or muscle damage that has happened. Comparing between the healthy and injured shoulder will help gauge the extent of damage. 
• MRI: This will provide a more detailed view of the shoulder structure to isolate the injury. 

Based on the findings from the tests above, a treatment plan will be drawn, where the orthopaedic will decide whether this needs physiotherapy or surgery. Traditional treatment includes rest, therapy and icing the region. But if the damage is severe, then surgery is the ultimate option.

Types of rotator cuff surgery

• Arthroscopic tendon repair: Here the orthopaedic surgeon will insert a tiny camera called arthroscope and tools, via small incisions to help the torn tendon reattach to the bone
• Open tendon repair: When an open tendon repair is a better option, your surgeon will operate through a larger incision to help the damaged tendon reattach to the bone
• Tendon transfer: If the tendon damage is beyond repair, your orthopaedic surgeon will use a nearby tendon as a replacement. This replacement will be done without impairing any other muscle group
  
• Shoulder replacement: Massive tears will ask for a shoulder replacement surgery by replacing the damaged joint with an artificial one through reverse shoulder arthroplasty

Post surgery, you’ll keep your shoulder on a sling to assist healing. Your surgeon will also advise the following: 

• Several times a day take off the sling and move your arm to get better blood flow. 
• For pain and swelling use an ice pack for 20 mins.
• Avoid lifting your arm unless the orthopaedic gives a green signal

How to prevent shoulder muscle tear?

To look after your muscles you must exercise. But this does not mean rigorous exerting exercise. By this we mean exercises that improve your blood circulation to make sure blood and oxygen reaches each muscle group. Good circulation is the best form of healing that will repair the tissues that are damaged over time. 

Sport physios all over recommend focusing on the front muscles of the chest, upper arm,and your shoulder, including the back. Strengthening these muscle groups will help even out the stress on your shoulder muscles that leads to this injury in the first place. 

In conclusion, rotator cuff injuries are common to sports persons, but can happen to anyone. Your motor mechanic can get it, and if you suddenly fell down and your shoulder broke your fall, then even you can get it. The best way out is to not panic but immediately seek medical help. The quicker an injury is attended to, the faster is the route to recovery. 

At the CK Birla Hospital, we have a special set of orthopaedic surgeons, dedicated to treat sports injuries like the Rotator Cuff Tear and provide you treatment or surgery that will involve minimal stay but complete recovery in the quickest possible time. So that you can go and play your favourite sport again. If you have a pain in your shoulder and want an expert opinion on it, then do walk in to any of our hospitals or book an appointment with Dr. Chirag Arora.