Rotator Cuff Tear
The rotator cuff is comprised of four muscles that come together to form the rotator cuff tendon: supraspinatus, infraspinatus, trees minor, and subscapularis. Persistent inflammation to the subacromial bursa and the rotator cuff tendons can often lead to tendonitis and eventually a partial or full thickness tear of the rotator cuff. Trauma or other repetitive use injury can also lead to a rotator cuff tear. The supraspinatus tendon is the most commonly injured tendon of the four tendons because it lies predominantly in the space between the acromion and the humeral head.
Symptoms & Diagnosis
Symptoms are similar to those of impingement syndrome- pain in the shoulder, pain radiating to the elbow, pain at night, and pain with activity. Most patients with a large rotator cuff tear complain of weakness and the inability to lift their arm to the front or to the side.
Diagnosis can usually be made by a good history and physical examination. x-rays, MRI or ultrasound are often used to confirm the diagnosis and to rule out any other pathology.
Non-surgical treatment includes PT, NSAIDS, lifestyle modifications and possible injections of steroid or other biologic options.
If non-operative treatment fails, shoulder arthroscopy, subacromial decompression and a rotator cuff repair is recommended. The AC joint and the biceps tendon are evaluated during the procedure and any damage to those areas is addressed at the time of surgery. Depending on the nature of the tear, the rotator cuff repair is performed either arthroscopically or through a mini-open procedure. Patients can expect to be in a sling for 3-6 weeks after surgery depending on the severity of the tear.
Physical therapy is started 2-3 weeks after surgery. Active range of motion is limited for the first few weeks. As healing begins to occur, active assisted range of motion and gentle strengthening are introduced. Recovery can take from 4-6 months depending on the quality of the rotator cuff and the repair.