Acute Tears of the Rotator Cuff: Why seek Help Immediately?

The rotator cuff is a group of muscles and tendons that are very important for shoulder function. This group includes the supraspinatus, infraspinatus, teres minor and subscapularis.

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Rotator cuff muscles and tendons

Tearing of one or more of the rotator cuff tendons represents one of the most common causes of shoulder pain. Cuff tears can occur secondary to a number of reasons, but most commonly due to either an injury, or “wear and tear” over time. Cuff tears that occur slowly over time may be handled without surgery. On the contrary, cuff tears that occur all of a sudden as a result of a discrete injury are typically best managed with surgery as soon as possible. In orthopedic surgery, these types of tears are referred to as acute rotator cuff tears.

When to suspect an acute cuff tear?

Acute cuff tears typically result in sudden loss of active motion after an injury. If a person had a completely normal shoulder, or at the most an occasional ache, and an injury results in pain and loss of power to move the shoulder, then an acute rotator cuff tear may have occurred. Most of the time, the shoulder can be moved a little, and others may be able to move the shoulder passively. Deformity, more severe pain, or complete inability to move the shoulder may indicate that a fracture or a dislocation has occurred instead.

Why seek help immediately?

A substantial loss of motion along with pain after an injury requires plain radiographs to rule out a fracture or dislocation. If an acute cuff tear has occurred, radiographs will be normal. Your health care provider will suspect that an acute tear has occurred based mostly on sudden onset of weakness after an injury. These tears need to be confirmed with magnetic resonance or diagnostic ultrasound.

If the diagnosis is missed for months, the muscle-tendon unit will retract, making repair more difficult and unreliable. Once retraction occurs, the tendon may not reach to the bone, or may need to be repaired under too much tension. This increases the chances of poor tendon healing. In addition, once the tendon tear becomes chronic, the muscle may atrophy and be partly replaced by fatty tissue (fatty infiltration). In this case, the power of the shoulder will never be the same, even if the tendon heals.

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Magnetic resonance of rotator cuff

What is the treatment for acute cuff tears?

Without surgery, rotator cuff tears do not heal. On the contrary, most acute tears will heal if repaired surgically within the first few days to weeks after the injury. Even if the size of the tear is very large, involving multiple tendons, it will likely still be fixable early on, since retraction will not have occurred yet.

Rotator cuff repairs are commonly performed arthroscopically: a camera is introduced in the shoulder through a puncture hole in the skin, and additional puncture holes are used to insert instruments and anchors. Anchors are small screw-like implants, commonly made of surgical plastic, with an eyelet to hold sutures and tapes. The repair is completed by passing these sutures and tapes through the tendon, and anchoring them to bone. Be ready for a slow, somewhat long recovery! Cuff tendon healing and restoration of motion and strength does take time.

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Arthroscopy of rotator cuff repair