Shoulder is a sensitive joint; pain in the shoulder can be very disabling as simple activities like eating, wearing clothes and having a bath become restricted. Shoulder pain with weakness in muscles commonly occurs due to poor function of the muscles controlling the shoulder. These muscles are known as the rotator cuff muscles. If these muscles are torn, the arm can only be lifted with support of other arm and lifting objects above shoulder height can be difficult.
Who are affected by rotator cuff problems?
Majority of patients are middle aged or in the older age group. Sometimes the rotator cuff can tear in younger age group after a serious/high velocity injury.
When should we get urgent attention for a shoulder problem?
A painful shoulder needs urgent attention; if the pain begins after an injury due to a tear in the tissues around the shoulder or due to joint dislocation or fractured/ broken bones around the shoulder – and, if you notice swelling around the shoulder or have a fever – an urgent consultation is needed.
Why surgery is required to repair the rotator cuff muscles, do they not heal like other muscles?
If there is a tear in the tendon or muscle, the arm cannot be lifted as the connection of the muscle and bone is lost. When the muscle contracts in the presence of a tear, it only pulls the tendon away from the bone. This constant pulling will shrink the muscle and makes restoration impossible, unless intervened in time. As a consequence, a Rotator cuff tear does not heal spontaneously by medications or physiotherapy, and hence require surgery to repair it to the bone attachment. When the tendon heals onto bone, normal arm function can be restored. As the muscle becomes weak after not being used for long time, exercise is needed to give it enough power to lift the arm after the tendon heals.
What happens if the rotator tear is not repaired?
Repairing the tendon restores near normal structure and function of the shoulder, but if left untreated the tear does not heal and the tear size can increase. Tears in the rotator cuff also increase in size with time and studies conducted on this subject have shown that the tear size increases in 50% of patients in two years’ time. If the tear is too large and the muscle shrinks in size, the normal mechanics of the shoulder are altered and this can lead to arthritis requiring a shoulder replacement. So please do not neglect rotator cuff tendon tear. The proverb “a stitch in time can save nine”is apt for the rotator cuff tear. In the shoulder “a repair in time can save the shoulder.”