A rotator cuff may be injured from extending your arm for bracing in a slip and fall accident or from bracing your hands on the steering wheel in a car accident or truck accident. In bracing, the shoulder sustains the force of impact; often resulting in an acute tear in the rotator cuff. The rotator cuff can also be damaged in side-impact motor vehicle accidents.
An MRI is the most common method of determining a rotator cuff injury. It can also provide more information on the shoulder, including the condition of the capsule, glenoid labrum muscles (shoulder socket muscles), and bone; but small tears may be missed. Ultrasound is a less expensive diagnostic tool that is gaining in accuracy, when read by an experienced clinician, and popularity. Small tears can be seen and measured in an ultrasound.
There are three classifications of rotator cuff tears:
- Partial thickness rotator cuff tears — appearance of frayed tissue
- Full thickness rotator cuff tears — there is a definite hole visible, but the tendon is still attached to the humeral head
- Full thickness rotator cuff tear with complete detachment from the humeral head — this usually results in significant impairment to shoulder movement
Treatment for Rotator Cuff Injury
There are basically two broad treatment options for a rotator cuff injury: surgical and non-surgical. In most traumatic injuries to the rotator cuff, a full thickness tear is sustained which requires surgery.
Surgery usually involves:
- debridement or cleaning the injury and removing loose fragments of tendon, bursa, and other debris to allow smooth rotation
- expanding the space for the rotator cuff tendon so it is not pinched or irritated, this may include shaving bone or removing bone spurs
- stitching the torn edges of the tendon together and to the top of the humerus
Here are three surgery options:
- open repair of the rotator cuff which requires a 2-3 inch incision on the top of the shoulder allowing the surgeon to view the shoulder and injury directly
- mini-open repair where the surgeon can reach the injury by splitting the deltoid muscle, an arthroscope is also employed in this method
- arthroscopic repair requiring three small slits
Rotator Cuff Injury Recovery
During the first three months, it is vital to follow the doctor’s orders pertaining to shoulder usage, weight lifting limits, and physical therapy. Range of motion exercises are usually started a week after surgery. Depending on the severity of the injury, significant improvements start at about 3 months and progress can continue for 12 months after surgery.
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