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Rotator cuff tears

The rotator cuff is made up of 4 muscles with 4 associated tendons that work to stabilize and move the glenohumeral joint (ball and socket joint). Usually the tendon is the structure involved and tears can range anywhere from microscopic tears to complete tears. The supraspinatus is the most commonly affected muscle/tendon, but tears can occur in any of the rotator cuff muscles.

 CAUSES:

    Acute: Fall on an outstretched arm or lifting something that is too heavy are common causes of acute tears.

    Chronic: Rotator cuff tears usually occur over time due to a weakening and degeneration of the tendon along with repetitive stress. A poor blood supply that often accompanies aging or bone spurs may also play a role in chronic rotator cuff tears.

 SIGNS/SYMPTOMS: Pain usually in the front or side of the shoulder that tends to be worse at night. The pain also seems to be worse with overhead activity or when reaching away from the body. Range of motion may be within normal limits, however may be weak and/or painful.

 DIAGNOSIS: Usually a lot can be discovered through a complete history. Questions such as how long the pain has been there, what provokes the pain, and a description of the pain can be helpful information in determining the cause of shoulder problems. A physical examination including range of motion, muscle testing and different orthopedic tests will be performed to attempt to isolate the source of pain. X-rays are only useful in showing bone spurs in the shoulder since muscles and tendons are not visualized on plain x-rays. An MRI will often be performed to demonstrate the tissues involved and the extent of damage.

 TREATMENT: The treatment depends on the severity, patient age, and activity level. For conservative care, avoid provocative motions such as reaching and overhead activity. Learning proper stretching and strengthening can help to avoid future flare-ups and chronicity. Chiropractic adjustments may also help to get the joint in the optimal position for healing. This treatment also depends on the severity of the tear. Low level laser therapy (LLLT) may afford relief by decreasing inflammation and pain. Any kind of anti-inflammatory (whether it is natural or synthetic) can also help. In cases where surgery is required or opted, talk with the orthopedic surgeon about the procedure and recovery. This is a painful surgery and recovery so know what is required ahead of time.

 COMPLICATIONS:

    Non-surgical: Continued loss of strength due to a worsening of the tear over time.

   Surgical: Infection, stiffness from scar tissue

 PROGNOSIS: This depends on the extent of the tear and what approach is used to treat it. Recovery from a surgical repair also depends on how much emphasis the individual puts on rehabilitation. Though it is a very painful recovery, improper rehabilitation will lead to chronic stiffness, decreased range of motion, pain, and loss of function.

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