Dr. Carlos Rebollón
Rotator cuff rupture in Panama
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Rotator cuff tear
Rotator cuff tear
Tear The rotator cuff is composed of a series of muscle tendons that surround the shoulder joint. Its main functions are to keep the humeral head within the glenoid cavity, preventing dislocation, and to provide support and mobility to the joint.
The shoulder has the greatest range of motion of any joint in the body, making it extremely prone to injury. The risk of shoulder damage increases due to factors such as age, participation in sports (such as tennis, volleyball, swimming, baseball, among others), and repetitive work involving overhead arm movements (such as painting, window cleaning, carpentry, etc.).
Generally, a rotator cuff tear causes a dull, tolerable pain during the day and becomes much more intense at night. However, the pain can also suddenly increase with certain arm movements.
WHAT IS A ROTATOR CUFF TEAR?
A rotator cuff tear can occur in any of the four muscles (supraspinatus, infraspinatus, subscapularis, or teres minor) that provide stability to the arm and contribute to precise joint movements.
Among all the muscles and tendons that make up the rotator cuff, the supraspinatus is the one most commonly injured. Supraspinatus injuries are common in throwing sports, gymnastics, and in older individuals with tissue degeneration.
A rotator cuff tear typically starts as a partial tear and progresses over time if not properly treated, eventually becoming a full tear.
PARTIAL ROTATOR CUFF TEAR
A partial rotator cuff tear refers to a tear that does not completely sever the connection between the muscles and the bone. This type of injury is more common than a full tear.
During a consultation, the specialist will assess the joint condition by palpating and applying pressure points in the area to establish a specific diagnosis. Sometimes, the orthopedic surgeon may need the support of imaging tests (ultrasound, magnetic resonance imaging, etc.) to determine the level of soft tissue tear.
Partial rotator cuff tears can be treated either conservatively or surgically, depending on the case.
MASSIVE ROTATOR CUFF TEAR
A massive rotator cuff tear occurs when the injury completely involves the tendon. These tears are usually longer than 5 cm and, in some cases, can affect more than two tendons simultaneously.
SYMPTOMS OF ROTATOR CUFF TEAR
The signs of a rotator cuff tear can be confused with those of other types of joint problems, such as shoulder tendinitis.
The most significant symptoms of a rotator cuff tear include:
Dull pain in the shoulder, which may radiate down to the elbow.
Discomfort when sleeping on the affected side.
Limitation in moving the arm in different directions.
Difficulty lifting the arm above the head.
Joint weakness.
SURGERY TO REPAIR A ROTATOR CUFF TEAR
Surgery to address rotator cuff damage can be performed using either a closed approach (arthroscopy) or an open approach. Let’s define each of them:
Arthroscopic Tendon Repair: This procedure involves inserting a visualization device called an arthroscope and other instrumental tools into the joint through 1 or 2 cm incisions, allowing the surgeon to reattach the affected tendon to the bone.
Open Repair Surgery: When the muscle damage is severe, open surgery is recommended to facilitate the reconnection of the torn tendon to the bone.
Tendon Transfer: This option is advisable for patients with complex tears in which the tendon undergoes extreme devitalization, making it unable to reconnect to another internal structure. In these cases, the surgeon replaces the torn tendon with a nearby healthy one.
Joint Replacement: In shoulder joint replacement, the affected bone parts are removed and replaced with artificial components to improve the stability and functionality of the joint. This surgery is commonly known as shoulder prosthesis or shoulder arthroplasty.
WHY DOES A ROTATOR CUFF TEAR OCCUR?
A rotator cuff tear can be caused by various external factors, including blows, falls, trauma, overuse due to repetitive sports or work activities, etc. They can also occur due to inevitable wear and tear of the human body, such as joint degeneration or bone calcification, both caused by aging.
CAN A ROTATOR CUFF TEAR BE TREATED WITHOUT SURGERY?
Yes, a significant portion of rotator cuff injuries can be effectively treated with conservative methods such as medication, ice, rest, and therapies.
Physiotherapy is widely recommended for patients with rotator cuff damage. When used as initial treatment, it focuses on specific exercises and techniques targeting the injured area to help the patient regain the previous joint flexibility while strengthening the other key structures of the shoulder.
Another popular alternative in rotator cuff treatment is steroid injection; in this case, a special pharmacological compound is injected directly into the joint to temporarily relieve pain, allowing the person to resume daily activities while avoiding any movements that could worsen the damage.
RECOVERY TIME AFTER ROTATOR CUFF TEAR SURGERY
The recovery time varies depending on the patient’s health and healing capacity, the type of surgical procedure, and the characteristics of the injury (size, depth, location, etc.).
After surgery, the doctor will immobilize the shoulder with a sling or immobilizer for several weeks to prevent joint movement, allowing the shoulder to heal and scar favorably. Additionally, the specialist will recommend physiotherapy sessions to aid in the recovery process.
Considering the above, the estimated recovery time after rotator cuff repair surgery can range from 3 to 6 months.
HOW TO PREVENT ROTATOR CUFF TEAR?
As we have seen, the rotator cuff is composed of multiple muscles, so the best way to prevent this type of injury is by strengthening the muscle tissues.
While people tend to train to achieve defined abs and toned legs, from now on, you should include shoulder stretching, strengthening, and elongation exercises in your daily routine.
Other recommendations include avoiding abrupt movements with your upper limbs and avoiding heavy lifting on your shoulders. If your intention is to engage in high-impact sports, seek guidance from a sports medicine professional who can provide you with all the tools you need for better sports performance and to prevent this and other future injuries.
