The rotator cuff is a network of four muscles and several tendons that form a covering around the top of the upper arm bone. It functions to hold the humerus in place within the shoulder joint and enables the arm to rotate.
Of the four muscles, one muscle – the supraspinatus muscle, is affected the most by tears which causes pain and significant disability among adults. In a partial tear, only an area of the tendon is damaged. In this type of injury, the tear does not go all the way through the tendon.
The incidence of rotator cuff damage increases with age and is most likely due to weakness and wear of the muscle. The correct incidence of partial rotator cuff tears is difficult to determine because 5% to 40% of people without any symptoms may actually have a torn rotator cuff.
Cause
A rotator cuff tear can be a result of a single traumatic injury. A cuff tear may also occur if there is a fracture dislocation of the shoulder.
Most tears, however, are the result of overuse of these muscles and tendons over a long period of time. People who are especially at risk for overuse are those who engage in repetitive overhead motions like baseball, tennis, weight lifting, and rowing.
Rotator cuff tears are most commonly found in people who are middle aged and older, particularly as a result of wear and tear. Younger people also may suffer from a rotator cuff tendon tear after an acute trauma incedent or repetitive overhead motions. Rotator cuff tears are common in older patients because their blood supply diminishes with age. Diminished blood supply contributes to tendon degeneration. The body’s ability to repair the damage caused to the tendon decreases with age and this can ultimately lead to a complete tear of the rotator cuff.
Symptoms
Pain is often the first symptom of this injury, and generally develops right after the trauma. Some patients report having pain for several months. Pain is felt when lifting the arm and lowering the arm from a fully raised position. There is weakness as you lift and rotate the arm. You may also hear a crackling sound when you move the shoulder in certain positions.
Symptoms may also develop gradually with repetitive overhead activity or following long-term wear. Pain in the front of the shoulder can radiate down the side of the arm. At first, the pain may be mild and occur only after an activity. Over time, you may have pain even while you are resting and at night when you are sleeping.
Complications
Due to limited use of your from this injury, you may develop frozen shoulder.
Diagnosis
The diagnosis of a rotator cuff tear is generally based on the symptoms and physical examination. Your doctor will ask you specific questions about your pain and its occurrence. He will examine the shoulder to see whether it is tender in any area or whether there is any deformity felt when palpating the area of pain. He will ask you to rotate your arm and will measure the range of motion of the shoulder in several different directions and will test the strength of the arm. X-rays, and imaging studies, such as MRI (magnetic resonance imaging) or ultrasound, are also helpful.
Your doctor may also examine your neck to make sure that the pain is not the result of a “pinched nerve ” in the neck or spine and also to rule out other conditions, such as osteoarthritis or rheumatoid arthritis.
X-rays are generally not helpful, but an MRI can better visualize soft tissue structures such as the rotator cuff tendons. Getting an MRI may be able to show how large the tear is as well as its location within the tendon itself or where the tendon attaches to bone.
Treatment
Treatment can be either conservative, medical,or surgical, but the decision on how to treat it is based on a patient’s severity of symptoms, functional requirements, and presence of other illnesses that may complicate a given treatment.
Give plenty of rest to your arm by limiting overhead activity. Apply ice on the painful area for fifteen minutes 2-3 times a day. Seek help to learn physical therapy to treat this injury from a physiotherapist. He may also teach you some strengthening exercises.
Anti inflammatory medications can help in reducing pain. Your doctor may also give you a steroid injection to relieve pain.
Surgery is recommended if nonsurgical treatment fails to relieve symptoms or the tear is very painful. If less than 50% of the tendon is torn, then the tear usually does not require repair.
The type of surgery performed depends on the size, shape, and location of the tear on the tendon.
PRP For Partial Rotator Cuff Tear
Platelet Rich Plasma (PRP) therapy is an exciting, relatively new way to treat partial rotator cuff tears. Rotator cuff repair has historically been quite challenging. Even as repair techniques have greatly improved, the failure or re-tear rate is between 10-30%. PRP therapy provides an alternative to rotator cuff surgery, physical therapy, anti-inflammatory medication and cortisone shots. Each of the aforementioned is a common form of treatment for rotator cuff injuries and tears.
Some individuals have been able to forgo surgery and other traditional therapies after undergoing PRP therapy. The ground-breaking treatment has been proven to speed up the rate of healing and improve the quality of tendon repairs. Studies back up these claims and have thus legitimized the use of PRP for partial rotator cuff repair.
PRP therapy is a relatively new procedure but one which has proven to be quite promising. Top athletes have used it to accelerate the healing process after being injured in their respective sports. Takashi Saito (MLB), Tiger Woods (professional golf) and Troy Polamalu (NFL)are just a few professional athletes who have undergone the procedure with considerable success. The powerful therapy is surprisingly simple. It harnesses the body own ability to heal itself, in particular it uses the growth factors found in blood platelets.
Platelets are extracted from the blood using a centrifuge. The centrifuge spins the patient’s own blood separating its components. The platelets are obtained and then injected into the site of the patient’s injury, which in this case, would be the rotator cuff. Platelets contain growth factors, which are known to expedite the healing process. It may also help to spur the regeneration of the tendons and muscles which make up the rotator cuff, while also helping to reduce pain.
Rotator cuff injuries are very painful. They can make it difficult, if not impossible, for the individual who has suffered one, to use their injured shoulder. Individuals that suffer from a partial tear in their rotator cuff may not be able to carry out, even the simplest and most mundane tasks. Combing ones hair, buttoning a shirt or reaching for something on a high shelf become extremely difficult. A person may not be able to do any of the aforementioned, plus many other common, everyday tasks.
Surgery, physical therapy, anti-inflammatory medications and cortisone shots are amongst the most common ways to treat a partial tear in the rotator cuff. Each has its advantages. Surgery isn’t close to being fool-proof. As mentioned above, the failure or re-tear rate is as high as 30%. Physical therapy can be beneficial but it takes awhile before a person experiences noticeable results Cortisone masks pain as do anti-inflammatory medications, but neither will repair the cuff.
PRP therapy may be utilized when a person doesn’t want to undergo surgery. It is also appropriate for individuals who want faster and surer results than physical therapy and the use of ant-inflammatory medications can provided. PRP therapy helps the body heal itself, not just decrease pain.
PRP therapy is much less expensive than surgery. Injections cost between $500 and $1500. Because most insurance companies won’t cover the procedure, a person will have to pay for it themselves. Those unable to pay $500 to $1500 per injection should ask their doctor about the possibility of making payments.
FAQs-Questions to Ask Your Doctor
- What can I expect from PRP therapy in regards to my rotator cuff injury?
- Have you used PRP therapy to treat any other of your patient’s rotator cuff tears?
- What will the recovery process look like?
- Why is PRP therapy most appropriate for my rotator cuff injury?
- If I undergo PRP therapy, will I need surgery to repair my rotator cuff at a later date?
Prognosis
Prognosis is generally good if treatment is initiated early.
Prevention
Rotator cuff exercises to strengthen the rotator cuff helps to stabilize the shoulder joint and reduce the risk of rotator cuff injuries. Avoiding lifting anything heavy. If you have to lift a heavy item, try using both of your hands to lift the item to distribute the weight evenly. Also take breaks after prolonged activities. Maintaining proper posture can also help in preventing rotator cuff tears.
Questions your physician may like to ask you about your condition
- How long have you had pain?
- What is your occupation?
- Do you play sports? If yes, what kind of sports?
- How many hours do you play daily?
- Do you exercise too?
- How many hours do you exercise?
- Do you have any other illness along with this?
- Have you tried any treatment at home for this condition?
- Have you tried taking any medicines for this condition?
- Did you get any relief from home measures or medicines?
