Rotator Cuff Tears
The rotator cuff is made of 4 tendons: the subscapularis anteriorly, the supraspinatus superiorly and the infraspinatus and teres minor posteriorly. They, along with the deltoid muscle, provide most of the strength and power in the shoulder. The supraspinatus and infraspinatus tendons are most frequently involved in rotator cuff tears.
Rotator cuff tears occur in the following situations
Acute tears: These happen suddenly as a result of trauma causing the tendon to tear, usually at its attachment site onto the humerus. There is severe pain and loss of shoulder function.
Chronic tears: These are more common, and these happen as a result of age and general wear and tear. These tears surprisingly can often give little in the way of symptoms. Pain typically presents after some new DIY regime at home, a new exercise programme or some innocuous fall or trauma that aggravates the underlying condition that was otherwise lying dormant in the shoulder.
What are the signs and symptoms?
With acute rotator cuff tears the patient will describe an injury/trauma to the shoulder with immediate symptoms. Pain is usually around the anterolateral aspect of the shoulder, which can refer to the bicep region. Symptoms will typically be accompanied by weakness and loss of shoulder function, especially overhead. Pain and weakness will often inhibit the patient from actively moving the shoulder, especially in the acute stages, but there should be no restriction passively to shoulder movements (someone moving the shoulder for you).
Degenerative cuff tears on the other hand often occur on a background of niggling and discomfort that could have been present for months or years. Symptoms are again typically anterolateral in nature; they don’t present with the gross functional weakness that happens with traumatic cuff tears but on testing there is usually demonstrable weakness. Surprisingly Research shows a high prevalence of rotator cuff tears in asymptomatic patients as we age Age-related prevalence of rotator cuff tears in asymptomatic shoulders – PubMed with rates as high as 80% in those aged over 80 years of age Rotator Cuff Tears in the Elderly Patients – PMC .
How are rotator cuff tears diagnosed?
Diagnosing a ‘symptomatic’ rotator cuff tear requires a careful clinical examination. When a tear is suspected, an ultrasound scan, but also sometimes an MRI scan, is arranged to confirm the size, including the degree of tendon retraction, location and the appearance of the rotator cuff musculature. This combined information from the clinical examination and imaging helps guide your treatment options.
X-rays may also be arranged to assess for any concurrent shoulder pathology, such as arthrosis or bony spurs in the space where your shoulder tendons run (subacromial space).
How are they treated?
The treatment of ‘symptomatic’ rotator cuff tears varies depending on a number of factors. These include the patient’s age, the nature of the tear (degenerative/traumatic), the size of the tear, the functional restrictions and severity of symptoms, any concurrent shoulder pathology and your personal choice once you have all the information to make an informed decision.
Young patients with isolated, acute, traumatic, full-thickness rotator cuff tears are usually offered surgery and quickly. This is to allow the best possible results from surgical management and to allow this high-demand patient to return to normal functional activities/sporting requirements.
On the other side of this are the elderly patients (70+ year olds) who have degenerative cuff tears. These are typically managed conservatively in the way of physiotherapy (deltoid rehab programme) +/- injections (subacromial space / suprascapular nerve block), with many of them settling with these methods and activity modification. If conservative management does fail in this cohort of patients, surgical management usually consists of a reverse shoulder replacement due to the irreparable nature of their degenerative rotator cuff.
In the middle is everyone else with a grey zone on what is there best management option. Making an accurate diagnosis early with imaging allows patient to make an informed decision about their treatment options and the general prognosis of their shoulder condition. Our team of specialist will guide you through this process.
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