Rotator cuff tear

Rotator cuff tears are problems of the rotator cuff muscles of the shoulder. One or more rotator cuff tendons may become inflamed from overuse, aging, a fall on an outstretched hand, or a collision. Sports requiring repeated overhead arm motion or occupations requiring heavy lifting also place a strain on rotator cuff tendons and muscles. Normally, tendons are strong, but a longstanding wearing down process may lead to a tear.

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Signs

Several signs may be present in a person with rotator cuff injury. Typically, a person with a rotator cuff injury feels pain over the deltoid muscle at the top and outer side of the shoulder, especially when the arm is raised or extended out from the side of the body. Motions like those involved in getting dressed can be painful. The shoulder may feel weak, especially when trying to lift the arm into a horizontal position. A person may also feel or hear a click or pop when the shoulder is moved, and often express an inability to sleep on affected side. It also may feel like a broken collar bone.

Diagnosis

Medical history and physical examination

Pain or weakness on outward or inward rotation of the arm may indicate a tear in a rotator cuff tendon. The patient also feels pain when lowering the arm to the side after the shoulder is moved backward and the arm is raised. A doctor may detect weakness but may not be able to determine from a physical examination where the tear is located. However, a systematic review of relevant research found that the accuracy of the physical examination is low.^[1] The Neer test^[2] and Hawkins-Kennedy test^[3][2] have a sensitivity of approximately 80% for detecting a tear. The drop arm test has a sensitivity of 10% to 35% but has high specificity .^[1]

Diagnostic tests

X-rays, if taken, may appear normal. Magnetic resonance imaging (MRI) can reliably detect a full tendon tear, and can also frequently detect partial tears. If the pain disappears after the doctor injects a small amount of anesthetic into the area, impingement is likely to be present. If there is no response to treatment, the doctor may use an arthrogram, a plain MRI, or an arthrogram-MRI(MRI with contrast injected into the shoulder joint) to inspect the injured area and confirm the diagnosis.

Treatment

Doctors usually recommend that patients with a rotator cuff injury rest the shoulder, apply heat or cold to the sore area, and take medicine to relieve pain and inflammation. There are many cold compression therapy products to relieve the pain and swelling as the shoulder begins to heal.

Other treatments might be added, such as electrical stimulation of muscles and nerves, ultrasound, or a cortisone injection near the inflamed area of the rotator cuff.

The patient may need to wear a sling for a few days, but caution should be taken not to rely on a sling as it will cause the shoulder to become immobile. Gentle exercises are necessary to maintain mobility. If surgery is not an immediate consideration, exercises and physical therapy are added to the treatment program to build flexibility and strength and restore the shoulder's function.

If there is no improvement with these conservative treatments and functional impairment persists, the doctor may perform arthroscopic or open surgical repair of the torn rotator cuff.

References

1. ^ ^{a b} Hegedus EJ, Goode A, Campbell S, et al (2007). "Physical Examination Tests of the Shoulder: A Systematic Review with Meta-analysis of Individual Tests". doi:10.1136/bjsm.2007.038406. PMID 17720798.
2. ^ ^{a b} Brukner P, Khan K, Kibler WB. Chapter 14: Shoulder Pain. Retrieved on 2007-08-30.
3. ^ ShoulderDoc.co.uk Shoulder and Elbow Surgery. Hawkins-Kennedy Test. Retrieved on 2007-09-12. (video)

• This article contains text from the public domain document "Questions and Answers about Shoulder Problems", NIH Publication No. 01-4865, available from URL http://www.niams.nih.gov/hi/topics/shoulderprobs/shoulderqa.htm
• Rotator Cuff Tears. Wheeless' Textbook of Orthopedics. A description of rotator cuff tears from Whealess'