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Rotator Cuff Tear Injury


  • The rotator cuff is a group of tendons connecting the upper arm bone (humerus) with the shoulder blade (scapula).  The rotator cuff consists of the tendons of four muscles: supraspinatus, infraspinatus, teres minor, and the subscapularis muscle.  The tendons of each muscle fuse together and wrap around the front, back and top of the shoulder joint.  The rotator cuff works to raise and rotate the arm, stabilizing the shoulder joint.
  • Rotator cuff tears can affect any of the four muscles, most commonly the supraspinatus tendon.

  • Shoulder pain -- the pain is located in the top front of the shoulder or the outside of the upper arm.  The pain gets worse when the arm is lifted in an overhead position.
  • Weakness of the arm depends on the severity of the rotator cuff tear.  Patients with complete tears cannot lift the affected arm at all.

  • A rotator cuff tear usually occurs as a result of overuse or trauma
    1. Overuse -- repetitive stretching of the rotator cuff may result in tendonitis and tearing.  This type of injury results from repetitive throwing, swimming and overhead lifting in baseball pitchers, swimmers and tennis players.  Jobs that require repeated overhead reaching are one of the common causes of rotator cuff injuries.  In these cases, repeated inflammation of rotator cuff (tendonitis) leads to tearing. 
    2. Trauma -- rotator cuff tears can be caused suddenly by severe shoulder traumas such as direct injuries from motor vehicle accidents, falling on an outstretched arm, direct impact to the shoulder during sports activities and lifting heavy objects.
  • The risk of the rotator cuff tearing increases with age.  As people age, the muscle and tendon tissues lose elasticity, becoming more susceptible to injuries.
  • Other risk factors are bony abnormalities and muscle imbalances.  Rotator cuff tears occur more often in people with bone spurs on the undersurface of the acromion (a part of shoulder blade which forms the roof of shoulder joint).  When the people elevate the arm, the rotator cuff is pinched between the humerus and bony spur of the acromion.

  • A physical examination to evaluate the range of motion, pain, weakness and instability.
  • Shoulder X-Rays detect the spur of the acromion and rule out other causes of shoulder pain.
  • A shoulder MRI reveals the tearing of a rotator cuff, even if it is only a small or partial tear.
  • Shoulder arthrogram -- a dye is injected into the shoulder joint to help the examining physician visualize the joint.  Leakage of dye out of the joint suggests a tear of the rotator cuff.

  • Conservative treatment for mild impingement or tendonitis of the rotator cuff suggests rest of the affected shoulder, anti-inflammatory medicine such as aspirin or ibuprofen, and physical therapy.
  • Surgery -- surgical repair of the rotator cuff tears
  • Acromioplasty (removal of the acromial bone spur)




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