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Rotator cuff tear

What is a rotator cuff tear?

A rotator cuff tear can be career-threatening for professional tennis players and other athletes.

A rotator cuff tear can also affect people who have to do a lot of lifting overhead at work.

The rotator cuff is a group of tendons and muscles in the shoulder, connecting the upper arm bone (humerus) to the shoulder blade (scapula). The rotator cuff tendons provide stability to the shoulder, and the muscles allow the shoulder to rotate.

Illustration of rotator cuff

While your shoulder is one of your most mobile joints, it's also somewhat weak. Too much stress can cause partial tears and swelling in the tendons of the rotator cuff. Abrupt stress may even cause one of the tendons to pull away from the bone or tear in the middle.

Rotator cuff tear and sport

Athletes prone to rotator cuff tears include:

  • Swimmers
  • Tennis players
  • Cricket players, especially bowlers

You can get a rotator cuff tear by

  • Falling on your shoulder
  • Using an arm to break your fall
  • Lifting heavy weights

What are the symptoms of a rotator cuff tear?

The symptoms of a rotator cuff tear include:

  • Pain in the shoulder and arm, which varies depending on how severe the tear is.
  • Weakness and tenderness in the shoulder.
  • Difficulty moving the shoulder, especially when trying to lift your arm above your head.
  • Snapping or crackling sounds when moving the shoulder.
  • Inability to sleep on the shoulder.

Most rotator cuff tears develop gradually. But they can happen suddenly too - you may feel a pop, intense pain and weakness in the arm.

To diagnose a rotator cuff tear, your doctor will give you a thorough physical examination. He or she will want you to move your arm in different directions to see what causes pain. In addition, your doctor may arrange the following tests:

  • X-ray of the shoulder with some special views
  • MRI scan
  • Arthrogram - a special type of x-ray or MRI done after a dye has been injected into the joint that enables your doctor to see the joint in more detail
  • Arthroscopy - a minimally invasive surgical procedure in which a tiny camera is inserted into the shoulder joint to get a look at the rotator cuff

These tests will enable your doctor to rule out other conditions and confirm that you have a rotator cuff tear. He or she may then refer you to an orthopaedic surgeon for treatment.

What's the treatment for a rotator cuff tear?

As bad as these injuries can be, the good news is that many rotator cuff tears heal on their own. You just need to give them a little time. You should also:

  • Rest the joint as much as possible. Avoid any movement or activity that hurts. You may need a sling.
  • Put ice on your shoulder two to three times a day to reduce pain and swelling.
  • Perform range-of-movement exercises if your doctor recommends them.
  • Consider physiotherapy to strengthen the joint.
  • Use anti-inflammatory painkillers such as ibuprofen as advised by your doctor. However, these drugs can have side effects, like an increased risk of bleeding and ulcers in the stomach so they should be used only occasionally, unless your doctor specifically advises you otherwise.

More severe rotator cuff tears require surgery. One approach is shoulder arthroscopy, which is usually an outpatient procedure. During the arthroscopy, the patient is put to sleep with a general anaesthetic. A small camera is inserted into the shoulder to examine and repair the rotator cuff tear. If the tear is very large or involves more than one tendon, a small incision may be necessary. After arthroscopy, the injured arm is likely to be in a sling for two to three weeks and physiotherapy will be needed.

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