What is a rotator cuff tear?

 

The rotator cuff is made of 4 muscles and tendons that surround the shoulder to keep the shoulder joint in the proper position. Rotator cuff injuries are very common and most commonly occur from overuse activity or a fall.  The most common muscle and tendon that is injured of the rotator cuff is the supraspinatus tendon tear.  A tear can be a partial tear of the tendon or complete tendon tear.

What are the anatomical structures I should be aware of in the rotator cuff?

Below is some information about the rotator cuff

The ‘shoulder joint’ is the interface between 2 primary bones:
1. Upper arm bone (Humerus)
2. Shoulder Blade (Scapula)

The ends of these two bones (humeral head and glenoid) are held together by a group of thick ligaments, called a joint capsule. Ligaments are strong bands of tissue that provide stability to joints, connecting bones to other bones, preventing them from moving too much and too far.
On the ends of each bone are cartilage; there is tissue called the labrum that cushions the humeral head and the glenoid.

On top of these components are tendons and muscles, including the important group called the rotator cuff. Tendons are strong pieces of fibrous connective tissue that attach muscles to bones. The four rotator cuff tendons include the supraspinatus (most commonly injured), subscapularis, infraspinatus, and teres minor.

How do I know If I have a rotator cuff tendon tear?

Patients report pain on top of their shoulders. Sometimes patients report pain at night. A physician can examine you to determine if the tendon is injured. They might consider imaging next to evaluate the tendon which could include an ultrasound of an MRI. Both imaging modalities can be used but ultrasound is equally effective compared to an MRI if the physician is trained in diagnostic ultrasound. Ultrasound is more affordable and can be performed in the office. When looking for physicians trained in ultrasound, consider RMSK certification trained physicians which is one of the certifications that he has.

What are treatment options for rotator cuff tears?

When rotator cuff tears initially happen, most of the time they are chronic injuries that happen over time. The first step in managing rotator cuff tendinopathy and partial tears is physical therapy to strengthen the rotator cuff muscles to help the tendon heal.

If physical therapy does not improve your pain or ability to perform activities, the next step is to consider injection. There are cortisone injections and orthobiologic injections. Cortisone can be injected in the subacromial bursa which coats the tendons and decreases inflammation. This reduces pain and enables you to complete the strengthening exercises in physical therapy which is the sustainable treatment to preventing future rotator cuff injuries.

Other injections to consider are orthobiologics. Orthobiologics include Platelet Rich Plasma (PRP), and microfragmented fat. Please speak with your physician to see if you are a candidate with these procedures. They can help with reducing pain and increasing function. PRP has been shown in several studies to be effective for partial rotator cuff injuries.

If injections do not provide relief, the next procedure to consider is a rotator cuff repair. This is where they stitch the tendon back together.
 

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PRP for Partial Thickness Rotator Cuff
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9495266/pdf/JRM-54-1434.pdf

PRP for Rotator Cuff
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8164813/pdf/12891_2021_Article_4288.pdf