Arthroscopy
Rotator Cuff Repair
Your shoulder is made up of three bones: your upper arm bone (humerus), your shoulder blade (scapula), and your collarbone (clavicle). The shoulder is a ball-and-socket joint: the ball, or head, of your upper arm bone, fits into a shallow socket in your shoulder blade. Your arm is kept in your shoulder socket by your rotator cuff. The rotator cuff is a group of four muscles (supraspinatus, infraspinatus, teres minor and subscapularis)that come together as tendons to form a covering around the head of the humerus. The rotator cuff attaches the humerus to the shoulder blade and helps to lift and rotate your arm. A lubricating sac is called a bursa between the rotator cuff and the bone on top of your shoulder (acromion). The bursa allows the rotator cuff tendons to glide freely when you move your arm. When the rotator cuff tendons are injured or damaged, this bursa can also become inflamed and painful.
When one or more of the rotator cuff tendons is torn, the tendon no longer fully attaches to the humerus's head. Most tears occur in the supraspinatus tendon, but other parts of the rotator cuff may also be involved. In many cases, torn tendons begin by fraying. As the damage progresses, the tendon can completely tear, sometimes with lifting a heavy object.
Tears Classification:
Based on Extend of tear
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Partial tear: This type of tear is also called an incomplete tear. It damages the tendon but does not completely sever it.
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Full-thickness tear: This type of tear is also called a complete tear. It separates all of the tendons from the bone. With a full-thickness tear, there is a hole in the tendon.
Based on the location of tear
Articular side tear
Bursal side tear
Causes
There are two main causes of rotator cuff tears:
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Injury and
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Degeneration.
Acute Tear
If you fall on your outstretched arm or lift something too heavy with a jerking motion, you can tear your rotator cuff. This type of tear can occur with other shoulder injuries, such as a broken collarbone or dislocated shoulder.
Degenerative Tear
Most tears are the result of a wearing down of the tendon that occurs slowly over time. This degeneration naturally occurs as we age. Rotator cuff tears are more common in the dominant arm. If you have a degenerative tear in one shoulder, there is a greater likelihood of a rotator cuff tear in the opposite shoulder -- even if you have no pain in that shoulder.
Several factors contribute to degenerative, or chronic, rotator cuff tears.
Repetitive stress: Repeating the same shoulder motions, again and again, can stress your rotator cuff muscles and tendons. Baseball, tennis, rowing, and weightlifting are examples of sports activities that can put you at risk for overuse tears. Many jobs and routine chores can cause overuse tears, as well.
Lack of blood supply: As we get older, our rotator cuff tendons' blood supply lessens. Without a good blood supply, the body's natural ability to repair tendon damage is impaired. This can ultimately lead to a tendon tear.
Bone spurs: As we age, bone spurs (bone overgrowth) often develop on the acromion bone's underside. When we lift our arms, the spurs rub on the rotator cuff tendon. This condition is called shoulder impingement, and over time will weaken the tendon and make it more likely to tear.
Symptoms
The most common symptoms of a rotator cuff tear include:
Pain at rest and night, particularly if lying on the affected shoulder Pain when lifting and lowering your arm or with specific movements Weakness when lifting or rotating your arm Crepitus or crackling sensation when moving your shoulder in certain positions Tears that happen suddenly, such as from a fall, usually cause intense pain. There may be a snapping sensation and immediate weakness in your upper arm.
Tears that develop slowly due to overuse also cause pain and arm weakness. You may have pain in the shoulder when you lift your arm, or pain that moves down your arm. At first, the pain may be mild and only present when lifting your arm over your head, such as reaching into a cupboard. Over-the-counter medication, such as aspirin or ibuprofen, may relieve the pain at first.
Over time, the pain may become more noticeable at rest, and no longer goes away with medications. You may have pain when you lie on the painful side at night. The pain and weakness in the shoulder may make routine activities such as combing your hair or reaching behind your back more difficult.
Treatment
If you have a rotator cuff tear and keep using it despite increasing pain, you may cause further damage. A rotator cuff tear can get larger over time; eventually, you may develop wear and tear or arthritis of the shoulder joint named “cuff tear arthropathy”, henceforth cuff repair play no Roll, and joint replacement surgery becomes inevitable for restoring the function.
Early treatment can prevent your symptoms from getting worse. It will also get you back to your normal routine that much quicker.
The goal of any treatment is to reduce pain and restore function. There are several treatment options for a rotator cuff tear, and the best option is different for every person. Your doctor will consider your age, activity level, general health, and the type of tear you have in planning your treatment.
Non-Surgical
Nonsurgical treatment options may include:
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Rest: Limiting overhead activity and sling immobilisation.
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Activity modification: Avoid activities that cause shoulder pain.
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Nonsteroidal anti-inflammatory medication: Drugs like ibuprofen and naproxen reduce pain and swelling.
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Strengthening exercises and physical therapy: Specific exercises will restore movement and strengthen your shoulder. Your exercise program will include stretches to improve flexibility and range of motion. Strengthening the muscles that support your shoulder can relieve pain and prevent further injury.
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Steroid injection
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PRP injection
Surgical
Indication for surgical treatment
Your symptoms have lasted 6 to 12 months.
You have a large tear (more than 3 cm), and the surrounding tissue's quality is good.
You have significant weakness and loss of function in your shoulder.
A recent, acute injury caused your tear.
Surgery to repair a torn rotator cuff most often involves reattaching the tendon to the humerus's head (upper arm bone). There are a few options for repairing rotator cuff tears.
Arthroscopic tendon repair: In this procedure, surgeons insert a tiny camera (arthroscope) and tools through small incisions to reattach the torn tendon to the bone.
Open tendon repair: In some situations, an open tendon repair may be a better option. In these types of surgeries, your surgeon works through a larger incision to reattach the damaged tendon to the bone.
Tendon transfer: If the torn tendon is too damaged to be reattached to the arm bone, surgeons may decide to use a nearby tendon as a replacement.
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Shoulder replacement: Massive rotator cuff injuries may require shoulder replacement surgery. An innovative procedure (reverse shoulder arthroplasty) installs the ball part of the artificial joint onto the shoulder blade and the socket part onto the arm bone to improve the artificial joint's stability.