What is Rotator cuff?

The rotator cuff is a group of four muscles and tendons in the shoulder. They help in raising and moving your arm upwards and away from the body. They keep the ball of the upper arm bone (humerus) in the shoulder blade socket.

What are parts of Rotator Cuff ?

• Supraspinatus - controls lifting (abduction) of the arm and keeps humerus head (ball) in place.
• Infraspinatus - causes external rotation and extension of your arm
• Teres minor - smallest muscle of the group that aids in external rotation of the arm.
• Subscapularis – It allows internal rotation of the arm while holding it straight out or lowering it.

What are causes of rotator cuff tear?

• Trauma (e.g. Trying to support something heavy in over-head position of arm, Direct fall on the arm)
• Degenerative wear and tear of muscle.

In most rotator cuff tears, the tendon is torn away from the bone; in some there is avulsion of a small fragment of bone along with the tendon.

Supraspinatus is most commonly involved tendon to tear.

In degenerative cases, the process of tear begins by repetitive micro-trauma causing fraying , which eventually leads to a complete tear.

What are symptoms of Rotator cuff tear?

• Inability to actively lift arm upwards
• Shoulder pain that worsens at night or when resting your arm
• Arm may feel heavy
• Popping or clicking feeling when moving your arm
• Dead arm sensation (pain, weakness, numb sensation)

How is a rotator cuff injury diagnosed?

MRI scan will help visualize complete extent of the tear along with associated injuries. X-rays are not capable of detecting these soft tissue injuries, although chronic (degenerative) tears may show reactive bony changes.

Treatment

It depends on the type and extent of tear as well as age and activity demands of the patient.

Most partial tears will heal by non-surgical management.

Nonsurgical treatment options include :

• Rest: Arm supported in an arm sling pouch.
• Activity modification: Avoid activities that cause shoulder pain.
• Nonsteroidal anti-inflammatory medication: Drugs like etoricoxib and naproxen reduce pain and swelling.
• Strengthening exercises and physical therapy: After a period of rest, strengthening the muscles that support your shoulder can relieve pain and prevent further injury.

Surgical Treatment:

A complete tear of the rotator cuff tendon usually necessitates a surgical repair in otherwise active individuals.

This is accomplished in a minimally-invasive way by arthroscopic repair of the torn tendon.

During this procedure, a small camera-like device (arthroscope) is inserted in the shoulder, which displays pictures on a TV monitor. Your surgeon uses these images to guide miniature surgical instruments to perform the repair. Small implants called suture anchors (screw-like devices with sutures coming out of its head) are then inserted in the bone at the original attachment site of the tendon. The sutures are passed through the substance of the tendon and knots tied at tear site.

• Rest: Arm supported in an arm sling pouch.
• Activity modification: Avoid activities that cause shoulder pain.
• Nonsteroidal anti-inflammatory medication: Drugs like etoricoxib and naproxen reduce pain and swelling.
• Strengthening exercises and physical therapy: After a period of rest, strengthening the muscles that support your shoulder can relieve pain and prevent further injury.