Your rotator cuff is made up of a group of muscles and tendons in your shoulder. It plays a very important role in giving you your ability to move your shoulder. Rotator cuff injuries are common and may be caused from long term overuse or a traumatic injury. Those caused by traumatic injury are often referred to as acute tears.
As reported by the American Academy of Orthopaedic Surgeons (AAOS), between 1998 and 2005, more than 5 million visits to doctors were attributed to some type of rotator cuff injury or problem. When you experience this common shoulder injury, it often involves some type of tendon tear. Four tendons make up the rotator cuff. These include the supraspinatus, the infraspinatus, the subcapularis, and the teres minor.
Rotator cuff tears can happen to people of all ages, both male and female. Older people are more likely to suffer injuries due to the wear and tear that naturally happens over time. They are also particularly common for people who participate in certain repetitive reaching and lifting activities for work. Certain "overhead" sports that are very demanding on athletes' shoulders like volleyball, javelin throwing, tennis, softball and baseball may also increase the likelihood of injury.
Symptoms of a rotator cuff tear can include muscular weakness and difficulty moving the arm, a grinding or cracking noise during arm movement, and pain (especially at night when putting pressure on the injury and/or during certain activities that may involve overhead movement). The pain from this injury can range with some people not feeling anything at all and others feeling considerable pain. Interestingly, pain is not directly related to the actual size of the tear.
Certain tests are done to diagnose tears looking at things like external rotation. Other injuries that may involve similar symptoms include things like tendinitis and bursitis and sometimes adhesive capsulitis.
The severity of the injuries can range from more mild to very severe. Tearing can be partial or full. Full thickness tears may involve the entire tendon and can also include injuries where the tendon detatches entirely from the bone.
These tendon injuries can vary in size from very small to extremely large or massive.
Here are 7 facts about massive rotator cuff tears for you to know.
1. A massive rotator cuff tear is defined as a tear that is greater than 5 centimeters in size or involves a tear of at least two of the four rotator cuff tendons.
2. Between 10 and 40 percent of all rotator cuff tears are classified as massive.
3. The majority of recurrent tears (approximately four out of five or 80%) are classified as massive tears.
4. Surgical repair of a massive tear tends to have a very high failure rate (with estimates as high as 94%).
5. High failure rate after surgical repair is attributed to the poor quality of the rotator cuff prior to surgical repair. Massive tears are associated with advanced fatty infiltration of the tendon which puts the fracture at risk for recurrent tearing.
6. What is very interesting is that even if the patient has a failed surgical repair of a massive rotator cuff tear, their pain will be significantly reduced. In addition, their function is often improved. Anatomical outcome is not associated with functional outcome. This means that even with a recurrent tear following surgical intervention, patients are more functional post-operatively.
7. There are some important risk factors in sustaining recurrent tears after surgery. These include: patients that are smokers, people who have a large tear size pre-operatively (greater than 5 centimeters), and fatty infiltration of the infraspinatinous tendon / muscle that is noted on the pre-operative MRI scan.
If you think you have some type of shoulder injury, you should consult with a qualified medical professional for an evaluation, physical examination, strength testing, and treatment recommendations. Sometimes you may need to have MRI or ultrasound as part of your medical evaluation. There are surgical and non-surgical options for treating a rotator cuff tear depending on many different factors. A board certified orthopedic surgeon and sports medicine doctor can provide you with an accurate diagnosis and your treatment options.
Dr. Stacie L. Grossfeld is a board certified Orthopaedic Surgeon practicing in Louisville, Kentucky. She graduated from the University of Louisville School of Medicine, and completed a fellowship in Sports Medicine at the Fowler-Kennedy Sports Medicine Center. Dr. Grossfeld currently works as an orthopedic surgeon in private practice at Orthopaedic Specialists. Dr. Grossfeld also serves as a clinical instructor in the Department of Orthopaedic Surgery at the University of Louisville. Her special interests are in knee and shoulder reconstruction and sports medicine. To learn more about her medical practice, check out Orthopaedic Specialists in Louisville, Kentucky.
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