Rotator Cuff Tear & Shoulder Muscle Tear
Rotator cuff tears are a very common shoulder problem in adults. Every year, thousands of people consult a doctor due to this problem. A torn rotator cuff causes weakness in the shoulder. This means that our daily activities, such as combing our hair, washing our heads or wearing clothes, become painful and difficult.
Anatomy
The shoulder is made up of three bones. occurs; humerus (arm), scapula (scapula) and clavicle (collar) bones. The knob of the humerus forms the shoulder joint with the socket of the scapula.
This joint is surrounded by the tendons of the muscles we call rotator cuff. The rotator cuff consists of 4 main muscles. These muscles allow the arm to lift up and rotate.
There is a sac on the shoulder called the bursa, which acts as a cushion. It is located between the acromion of the scapula and the supraspinatus tendon of the rotator cuff muscles. This structure allows the supraspinatus tendon under the acromion to rub against the bone and slide freely. In the inflammation or damage of this sac called the bursa, shoulder movements become painful.
Definition
It is the tearing of the rotator cuff at or near the place where it attaches to the humeral head. In many cases, the tendon first begins to wear out and as the condition progresses, it turns into partial or full thickness tears.
Causes
There are two main causes;Injury and degenerative
strong>Acute Tear
It may tear suddenly as a result of falling directly on the arm or lifting something heavy. Such tears may be accompanied by collarbone fractures or shoulder joint dislocation.
Degenerative Tears
It is a slowly developing condition over time, and the rotator tendons become thinner and wear out and tear. This state of degeneration is associated with aging. Rotator cuff tears most commonly occur in the dominant arm, and even if you have no pain, the other shoulder is at risk.
There are many reasons for degenerative tears;
- Frequent use: Stress occurs on the shoulder in sports such as tennis, volleyball and weightlifting. It may be due to time and frequent use. In many professions, this condition may occur as an occupational disease.
- Decrease in blood flow: With aging, tissue quality decreases as the blood flow to the shoulder decreases.
- Bone protrusions: The acromion of the shoulder bones grows curved or becomes protruding. If it occurs, it may rub against the rotator cuff and cause it to tear.
Risk factors
These tears are generally seen frequently after the age of 40 and aging is a risk. factor.
It may tear due to frequent use of the shoulder in certain professions and sports activities. (Carpet weavers, wall painters or in volleyball, tennis sports, etc.)
Although frequent use is a reason, it may sometimes be due to trauma in young people.
Clinical Findings
Rotator Frequent complaints in cuff tears;
- Shoulder pain that does not go away at night and at rest
- Increased shoulder pain when lifting the arm up
- Weakness in lifting the arm and turning it around its own axis
- Hearing friction sounds in the shoulder joint in certain positions
If the tear occurs suddenly in situations such as falling, severe shoulder pain occurs. A jumping sensation may be felt when lifting the arm.
Shoulder pain and weakness in the arm may occur in slowly developing degenerative tears. It is significant that the pain in the shoulder increases when you lift your arm sideways towards the other shoulder. Shoulder pain may be mild at first and should not be considered a part of life.
Over time, the pain may become unbearable and does not go away with rest. There is no response to medications and it may wake you up at night. Simple daily activities, such as combing hair and wearing clothes, can become painful.
Physician Examination
After discussing your complaints and medical history, your doctor will examine your shoulder joint, look at the range of motion of the shoulder joint, and evaluate the muscle mass. He will perform tests that provoke strength and pain.
Imaging
Bone structures are evaluated by taking x-rays. Bone changes such as type 2-3 acromion bone protrusion, acromion arm ball distance etc. are evaluated. MRI shows changes in soft tissues. Providing detailed information about the size of the tear, edema, etc.
Treatment
If you have a rotator cuff tear, pain usually increases as you continue to use the shoulder. This situation is associated with the progression of the tear over time. Chronic shoulder and arm pain is an important reason for you to see a doctor. Early diagnosis and treatment are important for successful results.
The main goal of treatment is to eliminate pain and regain shoulder functions. There are many different treatment methods for these tears and these methods vary from person to person. Age, activity level, type of tear, general health condition, etc. are effective in planning your treatment.
There are surgical and non-surgical treatment methods depending on the patient's condition;
Non-surgical treatment.
Some patients benefit from non-surgical methods;
- Rest: Inability to raise the arm above shoulder level and resting it with an arm sling
- Activity Regulation: avoiding movements that cause pain
- Medicine: Non-steroidal drugs, muscle relaxants
- Physical Therapy
- Local injection: If there is no response to the above conditions, steroids with local anesthetic injection is given.
Surgical Treatment
If non-surgical treatment methods are ineffective, your doctor will recommend surgery. Continuing pain is the main indication for surgery. If you are a very active person or use your arm a lot professionally, surgery may be recommended.
Surgery should be considered if the following situations occur;
- If you have had pain for at least 6 months,
- If the rotator cuff tear is large,
- If there is weakness and loss of function in the shoulder,
- If it wakes you up at night,
- Acute tears caused by a serious trauma.
There are many different repair methods among surgical methods. Your doctor will plan surgical treatment with you according to your condition.
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