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Rotator Cuff Tears
Dr Kau Chung Yuan (许医生)
MBBS (S’PORE)
MRCS (Ireland)
MMed (Ortho)
FRCSEd (Ortho)
What are Rotator Cuff Tears?
Rotator cuff tears are injuries that affect the shoulder’s rotator cuff, a crucial group of muscles and tendons responsible for stabilising the joint and facilitating arm movement. These tears are characterised by damage to one or more tendons in the rotator cuff and vary in type and severity.
The types of rotator cuff tears include:
- Partial Tears: This type of tear damages the tendon but does not completely sever it. It is also known as an incomplete tear.
- Complete Tears: Also known as a full-thickness tear, this occurs when the tendon is completely split into two parts or detaches entirely from the bone.
Rotator cuff tears can result from a single traumatic event or develop gradually due to repetitive shoulder movements. They are commonly observed in older individuals as a result of age-related tendon degeneration but can also occur in younger individuals, often due to acute injuries or repetitive use in certain sports or occupational activities.
Causes
The causes of rotator cuff tears can be broadly categorised into two groups: acute injuries and degenerative changes. Understanding these causes is essential for both prevention and treatment.
Acute Injuries
Acute injuries leading to rotator cuff tears typically occur from:
- Sudden Impact: Such as a fall on an outstretched arm or a direct blow to the shoulder.
- Excessive Force: Lifting an object that is too heavy or lifting in an awkward position can strain or tear the rotator cuff tendons.
- Rapid or Unusual Movements: Especially in sports, sudden or extreme arm movements can cause tears in younger individuals.
Degenerative Changes
Degeneration of the rotator cuff tendons is a more common cause in older individuals and results from:
- Age-Related Wear and Tear: As people age, their tendons gradually weaken and become more susceptible to tears.
- Repetitive Stress: Repeatedly performing the same shoulder motions, particularly overhead activities, can irritate and wear down the tendons over time.
- Reduced Blood Supply: As people age, the blood supply to the rotator cuff tendons diminishes, impairing the body’s natural ability to repair tendon damage.
- Bone Spurs: Sometimes, bone overgrowths (spurs) can develop on the underside of the acromion bone, which can rub against the tendon and weaken it, making it more prone to tearing.
Symptoms
The symptoms of rotator cuff tears can vary based on the severity and type of the tear, manifesting in several ways:
- Persistent Pain
Characterised by discomfort in the shoulder, particularly during activities involving lifting or lowering the arm, and at rest, often intensifying at night. - Reduced Strength
Demonstrated difficulty in lifting or rotating the arm, leading to impaired ability to perform routine tasks such as combing hair or reaching behind the back. - Limited Movement
Marked by a noticeable reduction in shoulder mobility, accompanied by stiffness, making it challenging to achieve a full range of motion. - Crackling Sensation
Identified by a feeling of crackling or popping in the shoulder during certain movements.
Diagnosis
The diagnosis of a rotator cuff tear typically involves a combination of clinical assessment and imaging techniques:
Clinical Examination
A thorough examination by an orthopaedic surgeon, focusing on the shoulder’s range of motion, strength, and pain points. Specific physical tests may be performed to assess the integrity of the rotator cuff.
Medical History Review
Discussing symptoms, activities leading up to the onset of pain, and any prior shoulder injuries, to provide context for the current condition.
Imaging Tests
- X-rays: Useful in ruling out other causes of shoulder pain such as arthritis or bone spurs but cannot visualise soft tissues like tendons.
- Ultrasound: A non-invasive test that provides images of the soft tissues, showing tears in the rotator cuff tendons.
- Magnetic Resonance Imaging (MRI): Offers detailed images of both soft tissues and bones. MRI is particularly effective in diagnosing the extent of the rotator cuff tear and assessing the condition of the surrounding tissues.
Non-Surgical Treatment Options
For many individuals with rotator cuff tears, non-surgical treatment can effectively relieve pain and improve shoulder function. These treatments include:
- Rest and Activity Modification: Limiting activities that cause pain and avoiding motions that aggravate the shoulder can be crucial in the healing process.
- Physical Therapy: Tailored exercises designed to strengthen the shoulder muscles, improve flexibility, and restore range of motion.
- Pain Management:
- Ice Application: Using ice packs to reduce swelling and relieve pain.
- Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Medications such as ibuprofen or naproxen can help reduce pain and inflammation.
- Corticosteroid Injections: Administered directly into the shoulder joint to provide temporary pain relief and reduce inflammation.
Surgical Treatment Options
Surgical intervention may be considered for rotator cuff tears, particularly when non-surgical treatments have not provided sufficient relief or in cases of severe tears. The main surgical options include:
- Arthroscopic Repair
A minimally invasive procedure where small incisions are made, and a tiny camera (arthroscope) guides the orthopaedic surgeon in repairing the rotator cuff using small instruments. - Open Tendon Repair
In some cases, particularly for large or complex tears, a traditional open surgical approach may be necessary to repair the torn tendon. - Tendon Transfer
If the torn tendon is too damaged to be reattached, a tendon from another part of the body may be used. - Shoulder Replacement
In patients with severe rotator cuff injuries and arthritis, replacing the damaged parts of the shoulder joint may be an option.
Dr. Kau Chung Yuan
MBBS (S’pore)
MRCS (Ireland)
MMed (Ortho)
FRCSEd (Ortho)
Dr Kau (许医生) is a Fellowship trained Orthopaedic Surgeon with a subspecialty interest in Hip and Knee surgery and has been in practice for more than 15 years.
He is experienced in trauma and fracture management, sports injuries, and joint replacement surgery.
- Fellow of the Royal College of Surgeons Edinburgh, Orthopaedics (FRCS, Edin) 2014
- Master of Medicine (Orthopaedics), Singapore (MMed) 2013
- Member of the Royal College of Surgeons Ireland (MRCS, Ire) 2009
- Bachelor of Medicine and Surgery (MBBS, Singapore) 2004
Prevention Measures
Preventing rotator cuff tears involves measures that protect and strengthen the shoulder. Key strategies include:
- Regular Exercise: Focusing on exercises that strengthen the rotator cuff and shoulder muscles to improve stability and flexibility.
- Proper Technique: Ensuring correct form and technique during physical activities, especially in sports or occupations involving repetitive arm movements.
- Ergonomic Adjustments: Modifying the workspace to reduce strain on the shoulder, particularly for those with desk jobs or manual work.
- Avoiding Overexertion: Being cautious not to lift objects that are too heavy and avoiding overhead activities that strain the shoulder.
- Warm-Up and Stretching: Incorporating a routine of warming up and stretching before engaging in physical activities to prepare the muscles and tendons.
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Frequently Asked Questions (FAQs)
How Long Does It Take to Recover from a Rotator Cuff Tear?
Non-surgical treatments generally require several weeks to several months for significant improvement. Physical therapy plays a pivotal role in recovery, focusing on exercises that gradually increase in intensity to strengthen the shoulder muscles and restore range of motion.
Surgical repair for more severe tears typically requires a longer recovery time. Initial healing post-surgery takes about 6 to 8 weeks, during which the shoulder may need to be immobilised. However, full recovery, including complete restoration of strength and function, can take up to a year.
Can You Still Move Your Arm with a Rotator Cuff Tear?
The ability to move the arm with a rotator cuff tear varies depending on the tear’s size and location. In cases of partial tears, individuals may still be able to move their arms, albeit often with pain and limited range of motion.
Complete tears may result in significant weakness or even an inability to lift the arm, particularly for movements that involve lifting or rotating the arm away from the body.
Is Physical Therapy Always Required for Rotator Cuff Tears?
Physical therapy is generally recommended for both non-surgical and surgical treatment paths of rotator cuff tears. It plays a critical role in reducing pain, improving shoulder function, and preventing further injury.
In cases where surgery is performed, physical therapy is essential post-operatively to regain shoulder function. Even in minor tears where surgery is not required, physical therapy can help in healing and prevent future injuries by strengthening the surrounding muscles and improving joint stability.
Can Rotator Cuff Tears Lead to Other Shoulder Problems?
If left untreated, rotator cuff tears can lead to other shoulder problems. Chronic tears can result in progressive muscle weakness and atrophy, reducing shoulder function and range of motion. This can make daily activities increasingly difficult and painful.
Over time, untreated rotator cuff tears can also lead to shoulder joint instability and may increase the risk of developing shoulder arthritis, a condition characterised by joint pain and stiffness. Persistent weakness and imbalance in the shoulder can also lead to altered joint mechanics, which may exacerbate wear and tear on other shoulder structures.