The rotator cuff consists of a group of muscles and tendons that hold the shoulder joint in place. These muscles, four in total, help keep the ball of the upper arm bone, or humerus, in the shoulder socket. They are also responsible for helping you raise your arm and rotate it.
Injury
The muscles of the rotator cuff are put into use on a daily basis. When you raise your arm, play a game of tennis, comb your hair, or reach for something on a high shelf. Because of constant or repetitive use, the tendons, fibrous connective tissue that attaches muscles to bone, can become torn. Repetitive use injuries occur in people who have an occupation that requires constant overhead movements such as a painter or with those involved in sports such as a baseball player, swimmer, or tennis player. An injury can also be the result of lifting something heavy or falling on the shoulder or on an outstretched hand. In addition, degenerative changes caused by aging can weaken the tendons and muscles and lead to tears.
According to the Department of Orthopaedic Surgery at the University of California in San Francisco, the rotator cuff injury is one of the most common conditions affecting the shoulder and is frequently found in people between the ages of 40 to 70. Age is often a contributing factor with 30 percent of those over the age of 60 experiencing at least a partial rotator cuff tear.
Symptoms
Symptoms include difficulty moving the arm over the head, pain at night that makes sleeping difficult, and the inability to lift objects. A weakness that increases in severity is also a frequent occurrence.
Treatment
Treatment of a tear in the rotator cuff may involve a physical therapy program that is designed to decrease the pain, increase the range of motion of the shoulder joint, and eventually strengthen the rotator cuff muscles. For those with significant dysfunction or those that do not respond to conservative treatment, surgery may be recommended.
There are two types of surgeries: open repair and keyhole surgery. Open repair is performed through an incision in the skin that exposes the rotator cuff. Keyhole surgery is also known as arthroscopy. Arthroscopic surgery is usually the first option because of the much smaller incision and quicker recovery time. The use of a miniature video camera helps the surgeon perform the operation from an incision about the size of a buttonhole. Larger tears, however, may require open surgery. Open surgery requires a two to three-inch incision in the deltoid muscle. The surgeon then attaches the tendon to the bone or repairs the tear. Patients usually go home the same day with their arm in a sling.
Recovery
It takes time to recover after surgery. Tendons receive a poor blood supply which slows down the healing process. Lifting is avoided for the first three months. After this time, most daily activities can be performed. This is accomplished through the rehabilitation efforts and exercises that your physical therapist provides. This treatment prevents scarring and stiffness and is important in recovering the flexibility and strength of the injured shoulder. Physical therapy usually continues anywhere from two to six months post-operation. Outside of these exercises, it’s important to not raise the arm away from the body or try to lift anything during the healing phase.
Depending on your job, you may need to wait a minimum of one to three weeks or up to several months following surgery to return. Most sports need to be abstained from for three to six months.
The good news: A study published in the Journal of Shoulder and Elbow Surgery followed 381 patients with full-thickness tears of the rotator cuff for a minimum of two years. These patients ranged in age from 31 to 90 years. Patients performed 6 to 12 weeks of nonoperative physical therapy focusing on basic rotator cuff strengthening and mobilization. After 12 weeks, only 15 percent had opted for surgery. Checking in with the participants after two years, “nearly 75 percent of patients avoided rotator cuff repair surgery by performing physical therapy despite having full-thickness cuff tears. “
Rehabilitation
For those who are undergoing the effects of a rotator cuff tear, consider calling 570-208-2787 or email cawleyptfrank@gmail.com to set up an evaluation. For other helpful articles and information, check out our Facebook or YouTube page.
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