What are Rotator Cuff Tear Symptoms?

 

What are Rotator Cuff Tear Symptoms?

What are rotator cuff tear symptoms ? Above all,  most common symptom is night pain. Secondly, pain with over head activity. Thirdly, there is difficulty with bringing you arm behind your back. Such as, putting your wallet in your back pocket or zipping up a dress.

Rotator Cuff Tears: Diagnosis and Treatment

Rotator Cuff Tears : diagnosis and treatment are questions I get asked daily as an orthopaedic surgeon. The rotator cuff is a group of four tendons that are located in the shoulder. When a portion of the tendon tears it can produce pain and disability https://orthoinfo.aaos.org/en/diseases–conditions/rotator-cuff-tears/

Where is the Pain From a Torn Rotator Cuff Tear Located?

The pain from a rotator cuff tear is located on the lateral aspect of the arm. Pain is in the area of the deltoid muscle. In addition, the pain radiates down the arm sometimes to the elbow.

What Causes the Rotator Cuff to Tear?

Most rotator cuff tears occur with age. Therefore , rotator cuff tears tend to be degenerative in nature. Traumatic cuff tears are less common. Traumatic cuff tears are closely associated with shoulder dislocations in people over age 60. In addition, a fall that results in a person landing on a flexed elbow can also traumatically tear the rotator cuff. However, it is rare to tear your rotator cuff if you are under age 40. Most cuff tears occurs in patient’s  50 years or older. As we age our rotator cuffs weaken. They can tear with just normal activities of daily living.

Key Findings on Physical Examination of a Rotator Cuff Tear

Key findings on physical examination of a rotator cuff tear are pain located over the lateral side of the upper arm. The  doctor will perform physical tests that include a Neer Test, Kennedy-Hawkins Test and place the shoulder through a range of motion . In addition, strength will be tested , pulses evaluated and sensation tested.

Imaging demonstrating the key examination tests for a rotator cuff tear

The image reveals the key physical tests to perform to document a rotator cuff tear

Imaging needed to Diagnosis a Rotator Cuff Tear

The initial imaging is a standard shoulder x-ray. If the x-ray does not reveal the source of shoulder pain a MRI will be obtained . A MRI will show soft tissue, bone edema, and detailed areas of arthritis that plain x-rays cannot reveal. However, if the patient has a pacemaker, MRI can not be obtained. In addition, it is difficult for claustrophobic patients to undergo a that study.

MRI of torn rotator cuff

The circle reveals where the rotator cuff tear is located on the MRI

 

Treatment of Rotator Cuff Tears

Treatment of a rotator cuff tear that is repairable, is surgery. There are some rotator cuff tears that are not reparable. Such as, massive tears with fatty atrophy and old chronic tears with significant retraction, are not amendable to surgery.

Surgery is outpatient . Secondary, the repair is arthroscopic. The surgery is relatively low risk. Smokers put the repair at risk for not healing. The nicotine in the cigarettes inhibit healing. A massive tear greater than four centimeters has a high rate of non-healing. In addition, tears were the rotator cuff is thin, avascular and friable have a difficult time healing even after the perfect surgical reconstruction.

 

Image of a torn rotator cuff tear at the time of surgery arthroscopically

A torn rotator cuff tear at the time of surgery arthroscopically

A repaired rotator cuff tendon

A repaired rotator cuff

 

Recovery after Rotator Cuff Repair

The recovery after a rotator cuff repair is around six months. However, improvement will continue to occur up to one year after the surgery. The recovery phase is three phases. First of all, in the  initial six weeks, the patient will not be able to actively rise their arm .working with a physical therapist will be part of the recovery. The second phase of recovery is from week 6-12.  . The last 6 week block of recovery is to focus on strengthening. During the three -six week phases you will be working with the physical therapist .