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Rotator cuff tears are a common cause of shoulder pain and discomfort which can lead to arthritis if left untreated. With the increase in the number of elderly patients, there is an increased incidence of these tears.
The rotator cuff is a group of muscles around your shoulder joint that combine together as a tendon and help in positioning your humeral head (ball) in the glenoid (socket) leading to painless movements of the shoulder. These muscles are Subscapularis, Supraspinatus, Infraspinatus, and teres minor. Among these muscles, Supraspinatus is most commonly found torn either alone or combined with other muscles
There are two main reasons for a rotator cuff tear- Injury, Degeneration
Rotator cuff tear due to injury is called traumatic rotator cuff tear and is seen in high-intensity shoulder injuries in young patients and following a shoulder dislocation in patients above 45 years of age.
Degenerative tears occur due to the aging process which can be due to the weakening of tendon by wear and tear or decreased blood supply to the muscle
The symptoms depend on the cause of the tear. Tears due to trauma can present as an inability to lift shoulder without support, inability to comb, or eat food with the affected shoulder. Tears due to the aging process can present as pain in the shoulder which is progressive in nature, mild difficulty in lifting the shoulder, or in cases of massive tears as the inability to completely lift the shoulder
Rotator cuff tears can be clinically suspected based on the symptoms and examination of the patient which can show pain and weakness of the affected shoulder, But confirmation of rotator cuff tear can be made on the basis of MRI or CT Arthrogram. Routine Xrays cannot confirm the presence of a tear.
The treatment of rotator cuff tear depends on the symptoms and expectations of the patients. For patients with advanced age and whose symptoms are only minimal, conservative management with medications and physical therapy is recommended. Patients who have severe symptoms and those who do not respond to conservative management will require surgery
Patients with massive tear defined as the involvement of more than two muscles will have more severe symptoms. Similarly, patients with tears due to injury also have severe symptoms. Moreover, since the rotator cuff is an elastic structure, the torn muscle will slowly retract thereby making delayed surgery difficult. Also, rotator cuff muscle has a peculiar property of muscle cells getting replaced by fat cells if the tear is not treated. This leads to the muscle getting torn during surgery thereby leading to high failure of surgery