스크랩 Rotator Cuff Tears

[전무수]

Rotator Cuff Tears

Also Known as: Tendon Tear, supraspinatus tendon tear

WHAT IS IT?

The rotator cuff is a group of tendons that connects the four muscles of the upper shoulder to the bones (see Anatomy). The strength of the cuff allows the muscles to lift and rotate the humerus (the bone of the upper arm). The tendons run under the acromion (part of the shoulder blade) where they are very vulnerable to being damaged. This can lead to a tear resulting in a painful, weak shoulder. A tear may result suddenly from a single traumatic event or develop gradually. When the tendons or muscles of the rotator cuff tear, the patient is no longer able to lift or rotate his or her arm with the same range of motion as before the injury and/or has significant pain associated with shoulder motion. The pain is also very common at night, often radiating down the arm.

As people age, it is normal for the rotator cuff tendon to wear and degrade, however only a small proportion of people develop pain and weakness that requires treatment.

Close up view of tear

Rotator Cuff Tendon Tear as seen at Open Surgery

 

Rotator Cuff Tendon Tear as seen at Arthroscopy
Click on Picture to see Video of the Tear being reduced with forceps

CAUSES:

1. Injury, especially while trying to lift or catch a heavy object
2. Overuse, especially after a period of inactivity
3. Poor blood supply to an area of the cuff (which occurs with increasing age)
4. A fall on an outstretched arm
5. A gradual weakening of the tendons of the shoulder, often associated with impingement

DIAGNOSIS:

A rotator cuff tear is best disgnosed with a scan. The type of scan depends on the local resources and skills.

1. Ultrasound Scan - in some cases this can be done immediately in the clinic and is accurate, dynamic and cost effective.
2. MRI Scan - This is more costly and less accessible, but can provide information on the quality of the muscles and other underlying structures of the shoulder.

We use Office ultrasound scans in the clinic routinely and MRI scans if we need information on the muscle quality (required for some surgical procedures)
 

PREVENTION:

o Avoid excessive overhead activities.
o Strengthen your shoulders and do not try to play or work through the pain.

TREATMENT:

1. Painkillers and anti-inflammatory medications
2. Physiotherapy - keeps your shoulder strong and flexible and reduce the pain and weakness
3. Cortisone steroid injections - reduces inflammation and control the pain
4. Surgery is required -
a. If the tear follows an injury
b. When pain and weakness is not improved with injections and physiotherapy
- The goal of any surgery is to relieve the pain and improve the shoulder strength. This requires a long period of physiotherapy in addition to the surgery.
- Surgery may be done Arthroscopically (keyhole) or Open, or a combination of the two, know as a Mini-repair.
- Some tears are too large to repair and then Arthroscopic Debridement may be performed to relieve the pain.