The rotator cuff is a group of four muscles in the shoulder that help to pull the shoulder socket in a downward direction. The rotator cuff muscles also work together to rotate the shoulder and arm with reaching movements. They attach from the shoulder blade bone into the top of the arm called the rotator cuff insertion. With age the tendon of the rotator cuff deteriorates, which makes it more vulnerable to injury.
Injury To The Rotator Cuff
Partial rotator cuff tears are twice as likely to occur than a massive rotator cuff tear. Injuries occur more frequently in older versus younger individuals. As the rotator cuff fibers begin to age they lose their strength and resistance to tearing. An injury is more likely to occur when the arm is raised up and away from the body. Overhead lifting is the primary cause. Tears occur usually where the muscle attaches to the bone.
Rotator Cuff Tear Classification
Rotator cuff tears are classified as either acute or chronic based on how long the injury has lasted. An acute injury is typically sudden, sharp or severe, lasting less than six weeks. Chronic is long lasting over six weeks and is typically aching, dull or throbbing in the type of pain that is experienced. Stiffness of the shoulder joint also occurs limiting overhead reaching movements. Reaching behind the back is also painful and limited.
Partial Thickness Tears Of The Rotator Cuff
Following an injury the body will attempt to repair a partial thickness tear. The tendon is still in good condition, but over time it will often progress with increased tearing to a full thickness tear. The problem is that the fibers of the tendon can not sustain continued stress with pulling objects or lifting. Another problem is that the blood supply to the area has been disturbed causing the injury location to begin to deteriorate.
Full Thickness Tears Of The Rotator Cuff
A rotator cuff full thickness tear is when the tendon is torn. Complete tears are rated as small from 0 to 1 centimeter squared. Medium is from 1 to 3 square centimeters. Large is between 3 to 5 centimeters squared. A massive complete tear is considered greater than 5 centimeters squared. About 50 percent of patients with a ruptured rotator cuff will recovery without having surgery. Rehabilitation with rest, pain management and exercise is the treatment of choice.
Surgery Considerations
Rehabilitation programs provided by a health care professional can improve a massive tear of the rotator cuff. Surgery is considered based on the age of the patient, the severity and time the injury has lasted, and if the patient has not responded well to therapy. Other considerations are the activity level of the patient and their expectations or demands. Always consult with a trained health care professional if you suspect a rotator cuff problem.
References
- "Physical Examinations Of The Spine And Extremities"; Stanley Hoppenfeld, MD; 1976
- "Foundations Of Clinical Orthopedics"; Stanley Paris, PT; 1990
