The challenge in defining a rotator cuff tear lies in its symptoms. According to Sport Med Center, the symptoms of a tear do not differ from those of rotator cuff tendinitis and impingement syndrome or other injuries to the shoulder.
Anatomy
The anatomy of the rotator cuff gives some understanding of why distinct disorders can appear so similar. The rotator cuff describes the point in the shoulder joint where the tendons of the supraspinatus, infraspinatus, subscapularis and teres major muscles come together to support the joint. These four muscles, together with their tendons, stabilize the shoulder, rotate the shoulder, lift the arm and exert pressure on the shoulder to control the movement of reaching overhead.
Definition
As with all injuries to the rotator cuff, the symptoms include inability or pain in raising arm, awakening during the night due to pain and, in some cases, pain in the neck or radiating pain down the arm. A tear in the rotator cuff involves one or more of the tendons. A large or full thickness tear means the tear spans the full thickness of that particular tendon.
Diagnosis
The literature points to two ways to diagnose a rotator cuff tear. Traditionally, a radiographic study---such as ultrasound, magnetic resonance imaging, arthrography or arthroscopy---were the only diagnostic tests that can make a definitive diagnosis, according to the University of Washington Orthopedics and Sports Medicine. On the other hand, doctors Eugene M. Wolf and Vivek Agrawal report that they came to a different conclusion: the doctors tested the accuracy of what they termed, "transdeltoid palpation," a method of pressing on and manipulating of the shoulder. They concluded that full-thickness tears were accurately diagnosed by them in 95.7 percent of the subjects.
Prevalence
Athletes such as swimmers, tennis players, weightlifters and baseball players have a high risk of damaging the rotator cuff. In the general population, the elderly experience the most rotator cuff tears, according to MD Guidelines. "The Journal of Shoulder and Elbow Surgery" reports that males, twice as likely as women to suffer a tear, often have engaged in heavy labor for a living.
Treatment
Initially, a conservative treatment is prescribed, which consists of rest, corticosteroid injections and anti-inflammatory medication for swelling. More aggressive treatment includes arthroscopy to remove bone spurs and repair small tears. In most cases, full-thickness tears require open surgery to repair the injured tendon. The patient can also opt for shoulder joint replacement. Without some form of treatment, the joint becomes weak and useless. An untreated rotator cuff tear can lead to a condition known as "arthropathy" in certain, but not all, patients. Arthropathy refers to any disease of the joint.
References
- Sports Medicine Orthopaedics: Rotator Cuff Tear; 2010
- Human Anatomy, 2nd ed.; Frederic H. Martini, Ph.D. and Michael J. Timmons, M.S.; 1997
- Imaging.Consult: Rotator Cuff Tear; 2010
- University of Washington Orthpedics: Rotator Cuff Treatment; 2005
- The Shoulder Center: Transdeltoid Palpation in the Diagnosis of Rotator Cuff Tears; 2001
- M.D. Guidelines: Rotator Cuff Tear, 2010
