Rotator Cuff Tear: Causes, Symptoms, Treatment and Cost

A rupture or partial-thickness tear of one or more of the muscles or tendons that make up the rotator cuff in the shoulder is what is known as a rotator cuff tear.

• Partial-thickness tear: This type of tear affects only one or two tendon fibres and is the least severe injury. It can cause pain and weakness in the shoulder, but may heal on its own with rest, physical therapy, and anti-inflammatory medications.
• Full-thickness tear: This type of tear damages all layers of the tendon and can be either a single or a double tear. It requires treatment such as surgery to repair the damage.
• Massive tear: This is a severe injury that involves more than two tendons being torn apart from each other. Surgery is usually required to repair this type of tear.

• Repetitive overhead motion: A rotator cuff tear often occurs from repetitive activities like throwing a ball, swimming, tennis or other overhead motions.
• Injury: Rotator cuff tears can also be caused by a direct injury or fall.
• Normal wear and tear: Over time, normal wear and tear on the tendon can lead to fraying and eventual tearing of one or more of the tendons surrounding the shoulder joint.
• Impingement syndrome: Rotator cuff tears can also be caused by long-term irritation from an impingement syndrome, which is when structures around the joint press against tendons during movement in a certain way causing them to rub against each other too much.

• Pain: Pain in the shoulder and/or arm is one of the most typical indications that a tear has occurred in the rotator cuff. It can range from mild to severe and may be localised to the shoulder or spread down into the arm.
• Weakness: A rotator cuff tear can cause weakness in the shoulder and arm, making it difficult to lift objects or perform daily activities.
• Limited Range of Motion: The pain and weakness associated with a rotator cuff tear can cause a decrease in range of motion in the shoulder and arm.
• Grinding Sensation: Some individuals experience a grinding sensation when trying to move their affected arm or shoulder due to the tendon rubbing against bone instead of gliding smoothly over it as it normally would without a tear.
• Crepitus: This is a crackling sound that may be heard when moving your affected arm or shoulder due to air bubbles present in the joint fluid caused by a rotator cuff tear.

• Strengthen shoulder muscles by performing resistance training exercises.
• Regularly warm up and cool down to reduce the risk of muscle strain.
• Avoid putting your arms through motions or postures that are too repetitive for a lengthy period of time.
• Take breaks from activities that can cause strain or impact on the shoulders, such as weightlifting, tennis or throwing sports balls, etc., when needed.
• Participate in regular recreational activities to increase coordination and balance in your shoulders and upper back muscles.

The most common diagnosis and tests for a rotator cuff tear include:

• Clinical Examination: During a clinical examination, the doctor will look for tenderness and swelling over the shoulder joint, as well as weakness or pain when certain movements are performed.
• X-ray: An X-ray image of the shoulder can help to identify bone spurs, which can be an indication of a chronic rotator cuff tear.
• Magnetic Resonance Imaging (MRI): MRI can detect rotator cuff tears more accurately than X-rays, as MRI images show soft tissues in addition to bone structures.
• Ultrasound: Ultrasounds can also be used to conduct an assessment of the rotator cuff muscles and tendons to find even the smallest tears that cannot be seen on other imaging tests such as X-rays or MRIs.
• Arthrography: An arthrography is an imaging test that involves injecting contrast dye into the shoulder joint, which then highlights any potential areas of injury during further imaging studies such as CT scans or MRIs.
• Electromyography (EMG): EMG tests measure electrical activity in muscles and can detect muscle abnormalities that may indicate rotator cuff tears, particularly those involving partial tears or tendonitis inflammation outside of complete tears in the tendon area.

• Loss of Mobility: A rotator cuff tear can cause a decrease in range of motion, or the ability to move your shoulder through its normal range of motions.
• Painful Movements: People with rotator cuff tears often experience pain when they try to lift their arm away from the body or out to the side. The pain may also occur when the arm is lowered back down after an overhead motion.
• Weakness: As the rotator cuff becomes increasingly damaged, a person may experience weakness in the shoulder muscles and be unable to lift objects as they normally would.
• Impingement Syndrome: People with rotator cuff tears are at an increased risk for developing impingement syndrome, which is caused by inflammation of tissues surrounding the shoulder joint that leads to pain and difficulty with movement.

• Take a warm oil massage on the neck and shoulder region, which helps in increasing local blood circulation and nourishes the damaged muscle area.
• Pinda Sweda is a traditional Ayurvedic technique where cloth bags filled with herbs are tied around the affected area to reduce pain and inflammation.
• Shirodhara, also known as third eye therapy, is another traditional Ayurvedic remedy that helps to relax the nerve function in muscles of shoulder and neck to relieve pain due to rotator cuff tear.
• Prepare concoction by boiling 2 tablespoons of castor oil in 1 cup of milk and drink it for about 2 weeks to reduce inflammation caused by rotator cuff tear.
• Include foods like ginger, garlic, onion, curry leaves, turmeric powder etc., in your diet as they help enhance joint mobility and reduce pain associated with rotator cuff tear

• Make it a priority to have a well-balanced diet that is abundant in nutrients that fight inflammation.
• Incorporate foods or supplements containing omega-3 fatty acids such as salmon and flaxseed oil as these have anti-inflammatory properties.
• Consume foods high in vitamin C like citrus fruits like oranges and grapefruits, bell peppers, tomatoes and leafy greens like kale to help the body form collagen for tissue healing.
• Increase intake of protein including lean meats like chicken, fish and legumes to aid in muscle repair and support healthy tendon healing processes.
• Balance electrolytes by incorporating potassium-rich foods such as bananas and potatoes to help decrease inflammation.

• High fat foods: Foods high in saturated fats, such as fatty beef, bacon, cheese and fried foods should be avoided when suffering from a rotator cuff tear. Some foods are challenging to digest and have been shown to enhance inflammatory responses.
• Processed and Refined Foods: Highly processed foods like white breads and pastas provide refined carbohydrates with little nutritional value, so should be avoided by people with rotator cuff tears.
• Alcohol: Alcohol has been known to interfere with pain medication and can also cause dehydration which can make an injury worsen or take longer to heal.
• Dairy Products: Though dairy products are typically high in calcium, eating too much of them can increase levels of inflammatory compounds in the body which can delay the healing process for rotator cuff tears so they should be minimised or avoided altogether when suffering from the injury.

• Arthroscopic Debridement: Arthroscopic debridement is a minimally invasive surgical procedure that involves removing pieces of torn or damaged tissue from the shoulder joint.
• Subacromial Decompression: This procedure involves releasing the compressed tissue under the acromion to reduce pain and improve range of motion in the shoulder.
• Rotator Cuff Repair: If there is significant damage to the rotator cuff, surgical repair may be needed to restore full range of motion and strength in the shoulder joint. It typically involves suturing or stitching together torn tendons and reattaching them to the humerus bone as well as attaching anchors or screws into surrounding bones for extra stability if necessary.
• Open Repair Surgery: During an open repair, a large incision will be made at the site of injury, allowing your surgeon direct access to stitch together and repair your rotator cuff.

If you think you may have torn your rotator cuff, it is advisable to get it checked out by an orthopaedic surgeon as soon as possible.

• NSAIDs: Examples of non-steroidal anti-inflammatory medicines (NSAIDs) include ibuprofen, naproxen, aspirin, and celecoxib (Celebrex). They have the potential to alleviate both pain and inflammation.
• Steroid injections: These injections contain corticosteroids that may be more effective than oral medication in providing pain relief.
• Muscle relaxants: These drugs act on the nervous system to help lessen muscle spasms that can develop with rotator cuff tears. Examples of commonly prescribed muscle relaxants include baclofen, carisoprodol, diazepam, and cyclobenzaprine.
• Pain relievers: For moderate to severe pain, a prescription opioid such as codeine or oxycodone may be prescribed for short-term use only.

Generally, mild tears may take around 6 to 12 weeks for complete recovery, while more severe tears may require 3 to 4 months with physical therapy.

In general, nonsurgical treatments such as physical therapy, rest, medications, and injections are effective in reducing pain and improving function.

However, these treatments may not be permanent and the tear may reoccur if the underlying cause is not addressed or if there is an increase in activity or stress on the shoulder.

Surgery is typically recommended for more severe tears, as it can provide more long-term relief.

• Avoid activities or movements that cause pain in the shoulder or arm.
• Avoid any activities that involve reaching behind your back, such as putting on a shirt or reaching for a wallet in a back pocket.
• Avoid lifting anything heavy (more than 5 lbs) with the affected arm until your doctor gives you permission to do so.
• Sleep on your back or the unaffected side with a pillow between your arms to prevent movement of the affected arm during the night.
• Use an ice pack for 20 minutes at a time, several times a day, to reduce inflammation and swelling around the tear site.
• Participate in physical therapy exercises designed to improve range of motion and strength around the shoulder joint and muscles surrounding it.

Generally, arthroscopic rotator cuff repair costs anywhere between ₹50,000 - ₹2 lakh while traditional open surgery is more expensive and can cost up to ₹3-4 lakh.

• Pain and stiffness: Treatment for rotator cuff tears may cause additional pain and stiffness in the affected shoulder, especially when strength and range of motion exercises are undertaken.
• Limited range of motion: Treatments may also lead to a temporary reduction in shoulder mobility and range of motion, although this can be managed with physical therapy.
• Shoulder weakness: Mild to moderate shoulder weakness is normal after rotator cuff surgery, but full recovery usually occurs over time with physical therapy and rehabilitation exercises.
• Infection: Infection is a potential complication associated with any surgery, particularly if the condition was present before the operation or is likely to be caused by microorganisms introduced during an operation or through contact with hospital personnel or equipment-related contamination.

You should see a nearby doctor if you have any Rotator cuff tear issues since they can lead to things like weakening, impingement, loss of mobility, soreness, etc., and the length of the treatment programme will depend on how severe the problem is. With proper treatment, many people can make a full recovery from a rotator cuff tear.