Rotator Cuff Tear
Rotator Cuff Tear
Rotator cuff tears are the leading cause of shoulder pain and shoulder-related disability. The rotator cuff is a common name for the group of 4 distinct muscles and their tendons; supraspinatus, infraspinatus, teres minor, and subscapularis. They provide strength and stability during shoulder motion.
The pathogenesis of rotator cuff tears is still partly unknown. However, they can be caused by degenerative changes, repetitive micro traumas, severe traumatic injuries, atraumatic injuries and secondary dysfunctions.
Traumatic injury to the rotator cuff can be caused by falling on an outstretched hand, by an unexpected force when pushing or pulling, or during shoulder dislocation.
Normal age-related muscle deterioration and excessive repetitive motions are examples of atraumatic causes.
Individuals with a rotator cuff tear may suffer from: Severe pain at time of injury, Pain at night, Pain with overhead activities, Positive painful arc sign, Weakness of involved muscle, and Shoulder stiffness.
Conservative management is warranted in most rotator cuff injuries. In addition to physical therapy, non-surgical treatment may include non-steroidal anti-inflammatory drugs and steroid injections, time, local rest, application of cold or heat and massage.
It is important to isolate the individual rotator cuff muscles as much as possible. This is because the rotator cuff muscles can become fatigued, injured or atrophied individually.
Physical therapy has a beneficial effect in the treatment of rotator cuff tears. Goals of the rehabilitation, nonoperative and postoperative, are reducing pain and muscle tension, improving wrong humeral head position, strengthening the stabilizing muscles and regain proprioception and mobility. Physical therapy consists of passive and active mobilization and strengthening exercises. Late stages of rehabilitation of rotator cuff injury include progressive resistive strengthening, proprioception training and sport-specific exercises.
There are three types of surgical treatments to repair rotator cuff tears:
Open repair- A traditional open surgical incision is often required for large or complex tears
Arthroscopic Repair- An optical scope and small instruments are inserted through small puncture wounds instead of through a larger incision. The operation can be carried out under visual control via a video display.
Mini-Open Repair- a technique that allow surgeons to perform a complete recovery of the rotator cuff through a small incision of generally 4 to 6 cm.