Rotator cuff rupture or rotator cuff tear is an injury in the shoulder area that usually requires treatment. While prevention is limited, early treatment can often restore full function.
What is a rotator cuff tear?
A rotator cuff rupture is a tear of the so-called rotator cuff. This rotator cuff is located in the shoulder and is partly responsible for stabilizing the shoulder joint. A rotator cuff rupture can affect four different muscles with associated tendons that belong to the rotator cuff; for example, the superior or inferior spinae muscle or the subclavian muscle. The symptoms associated with a rotator cuff rupture depend, among other things, on the extent of the rupture; however, it is not uncommon for smaller ruptures to result in greater pain than more severe tears do. Characteristic signs of an existing rotator cuff rupture are primarily shoulder pain, which varies depending on different loads and positions of the rotator cuff. Typically, a rotator cuff rupture results in pain with a lateral arm raise, for example. Rotator cuff rupture predominantly affects men who have already reached the age of 30.
Causes
A rotator cuff rupture can be due to a variety of causes. In most cases, a rotator cuff rupture only occurs if corresponding tendons already have previous damage. One possible cause of a rotator cuff rupture is, for example, so-called degeneration, i.e. wear and tear of the rotator cuff. Such wear and tear can be promoted, for example, by many years of occupational activities that include a lot of overhead work or by so-called overhead sports; these sports include, for example, golf or tennis. Another cause of a rotator cuff rupture can be an impairment of the tendons caused by a lack of space of corresponding tendons in the shoulder area. Finally, accidents can also lead to rotator cuff rupture, such as falls on the shoulder or arm.
Symptoms, complaints and signs
Rotator cuff rupture is characterized by the appearance of various symptoms. These are mainly pain in the shoulder. These may appear suddenly or develop gradually, depending on the extent of the tear. In most cases, the pain is position- or load-dependent. In addition, they often occur at night when the patient is lying on the affected side of the body. Lifting the affected arm laterally against resistance also usually results in pain in the upper arm or shoulders. It hurts particularly severely when the angle of abduction is between 60 and 120 degrees. With smaller tears, however, the rotator cuff rupture can even remain asymptomatic. However, it also happens that the pain slowly develops and intensifies over a period of about two days. Older people often suffer from very slowly increasing pain over a longer period of time. This can make it more difficult to diagnose the disease in them. Overall, the symptoms lead to a decrease in strength in the arm. As a result, those affected can no longer perform certain activities. The symptoms depend, among other things, on whether the tear occurred before or after tendonitis, whether the cuff is partially or completely torn, and the time period over which the changes developed. In severe cases, pain occurs even at rest.
Diagnosis and course
Rotator Cuff Rupture
A suspected diagnosis of rotator cuff rupture may initially be made on the basis of typical painful symptoms in the shoulder; a characteristic weakening of the muscles associated with rotator cuff rupture may also substantiate a suspected diagnosis. Both muscle weakening and impaired movement can be further determined by a diagnostician during a physical examination with the help of various tests.For a detailed diagnosis, so-called imaging procedures can be used in a further step if necessary; these include, for example, X-ray or ultrasound examinations. In principle, the course of a rotator cuff rupture depends, among other things, on the extent of the rupture. However, if a rotator cuff rupture is detected early and, if necessary, treated medically, full functional capacity can be regained in most cases.
Complications
Depending on how severe the rotator cuff rupture is, various complications are possible. This risk is considered particularly high if proper treatment of the tear does not occur. One of the conceivable sequelae of a rotator cuff tear is joint wear (omarthrosis) of the shoulder. In medicine, this form of arthrosis is also referred to as defective arthropathy. Another possible effect is the so-called frozen shoulder (frozen shoulder). In this case, movement restrictions of the shoulder joint appear, which cannot be reversed even with the help of treatment. If the rotator cuff rupture is due to wear and tear, which is the case in most patients, the affected tendons can repeatedly rupture again at a later stage. The greater the extent of the previous damage, the more likely it is that the tendon will rupture again. In cases of severe impairment, the frequency of repeated ruptures is around 70 percent. After accounting for severity, an average of one in four patients will experience a repeat rotator cuff rupture during their lifetime. If the rotator cuff tear is treated surgically, there is also a risk of complications. These primarily include wound healing problems, infections, mobility limitations, another rotator cuff rupture, and a permanent strength deficit. In addition, residual symptoms may remain. Injuries to the nerves may result in paralysis or sensory disturbances. It can take four to six months before the patient no longer feels any discomfort after the operation. Activities that put stress on the shoulder should not be performed again until after three to four months to avoid negative effects.
When should you see a doctor?
A rotator cuff rupture should always be examined and treated by a physician. It is usually not possible for this condition to heal itself, so the patient will always need medical treatment. This can prevent further complications. A doctor should be consulted for rotator cuff tears if the affected person suffers from severe pain in the shoulder. It is not uncommon for this pain to spread to other regions of the body, where it can cause discomfort. This pain can also occur at night, disturbing the affected person’s sleep. In most cases, the pain occurs when the affected person strongly rotates or bends his shoulder. Furthermore, a decrease in strength in the arms may also indicate a rotator cuff rupture and should be investigated. In the first instance, rotator cuff rupture can be investigated by a general practitioner. Further treatment may also require surgical intervention in some cases.
Treatment and therapy
In most cases, a rotator cuff rupture necessitates medical treatment. In this context, a specific therapy for rotator cuff rupture is based on various factors: first, the severity of the present rotator cuff rupture plays a role; for example, there may be a complete tear, but also only a tear of one or more tendons. Furthermore, an adapted therapy depends, among other things, on the severity of the pain, the age of the patient and the degree of rotator cuff strength required. The aim of the therapy is to restore the strength and functionality of the affected shoulder and to achieve freedom from pain. Treatment of a rotator cuff rupture can be either surgical or conservative (without the use of surgical measures). Surgical treatment of a rotator cuff rupture is often possible with the help of a so-called arthroscopy (a joint endoscopy); this method, also known as keyhole surgery, makes a so-called open surgery with a large skin incision unnecessary.Possible components of conservative treatment for rotator cuff rupture include anti-inflammatory and pain-relieving medications or injections, as well as physical therapy (physiotherapy).
Prevention
Preventing a rotator cuff rupture is possible only to a limited extent. If the tendons are already damaged, long-term overhead activities pose a risk for suffering a rotator cuff rupture. For example, for amateur athletes who have already suffered a rotator cuff rupture, it may make sense to practice a sport that places limited stress on the arms and shoulders. Occupations that require frequent overhead work include painting and varnishing.
Aftercare
Aftercare is especially necessary when rotator cuff rupture is treated surgically. Following surgery, the rotator cuff requires sufficient rest to heal. It usually takes six to eight weeks before the patient is able to bear weight. A special cushion is placed on the patient for rest. This must be worn consistently for a period of four to six weeks. The cushion should only be removed for dressing or cleaning the body. In addition, he must not move the treated arm in either the lateral or anterior direction. Thus, there is a risk of a renewed rotator cuff tear. Immobilization of the treated arm can also be done by a sling (orthosis). Mobilization of the shoulder proceeds passively and is performed as part of physiotherapy. This means that the patient is not allowed to move his arm himself. Thus, the movements take place exclusively through the therapists. Passive mobilization is later followed by active mobilization. This allows the shoulder to move independently again. Strengthening the muscles also plays an important role. However, the shoulder should not be subjected to heavy loads for about ten to twelve weeks. Physiotherapeutic follow-up treatment can restore the shoulder’s ability to function in everyday life, which can take up to six months.
What you can do yourself
This painful condition belongs in the hands of a doctor. The family doctor will decide whether conservative or surgical treatment is needed in this case. On its own, the rupture will not heal; moreover, a rotator cuff rupture usually leads to further ruptures. This is the reason why from now on sports such as climbing, golf or tennis may no longer be practiced. Even if patients are able to lift their arm above their head again without pain after successful treatment, they provoke a new rupture by doing so. This also applies to people with occupations that require working overhead, such as painters and varnishers. Here it is recommended to retrain. A rotator cuff rupture can lead to joint wear and tear and thus to omarthrosis, a certain form of arthrosis. To prevent this, patients are advised to take their painkillers, such as ibuprofen, regularly, as they not only inhibit pain but also inflammation. Alternative medicine also recommends various dietary supplements and phytotherapeutics that are believed to have anti-inflammatory properties. These include certain enzymes such as bromelain, as well as glucosamine, chondroitin, cat’s claw, boswellia serrata (frankincense) and the sulfur compound methylsulfonylmethane, or MSM for short. More detailed information on their intake and efficacy is available from physicians with a naturopathic background or appropriately specialized alternative practitioners.
