After surgery, patient need to keep his/her shoulder in a sling for 3 to 4 weeks. Physiotherapist will also demonstrate gentle, passive, pain-free range-of-motion exercises.After 4-6 weeks the sling is removed, patient will need to do range of motion and flexibility exercises and gradually start to strengthen biceps. Athletes can usually begin doing sport-specific exercises at 6 weeks after surgery, although it will be 3 to 4 months before the shoulder is fully healed.
Rotator Cuff Tears
The rotator cuff consist of four muscles and several tendons that form a covering hood around the top of the upper arm bone (humerus). These muscles form a hood around the head of the humerus. The rotator cuff holds the humerus in place in the shoulder joint by leavering the head down within the socket when you lift your hand above shoulder level and enables the arm to rotate.
Rotator cuff tear is a common cause of pain and disability among adults. Most tears occur in the supraspinatus muscle, but other parts of the cuff may be involved.
The rotator cuff helps to lift and rotate the arm and to stabilize the ball of the shoulder within the joint. The rotator cuff is constitutes of four muscles and their tendons. These combine to form a ” cuff ” over the upper end of the arm (head of the humerus). The rotator cuff covers the head of the humerus and stabilizes the shoulder joint.The four muscles of the cuff (supraspinatus, infraspinatus, subscapularis, and teres minor muscles) are attached to the shoulder blade(scapula) on the back through a single tendon unit. The unit is attached on the side and front of the shoulder on the greater & lessor tuberosity of the humerus.
The tear could be either be partial or complete.The partial tear could be on the top or under surface if the rotator cuff muscle
A tear can occur within the muscle
The rotator cuff can be torn from a single episode of injury. Patients often report recurrent shoulder pain for several months and a specific injury that triggered the onset of the pain. A cuff tear may also happen at the same time as another injury to the shoulder, such as a fracture or dislocation.
Most tears, however, are the result of repetitive overuse of these muscles and tendons over a period of years. People who are especially at risk for overuse are those who engage in repetitive overhead motions. These include participants in sports such as baseball, tennis, weight lifting, and rowing, javelin throw, wrestling,cricket.
Rotator cuff tears are most common in people who are over the age of 40. Younger people tend to have rotator cuff tears following acute trauma or repetitive overhead work or sports activity.
Rotator cuff tear may often happen as a result of wear and tear specially in people of above age 55-60years
Some of the symptoms of a rotator cuff tear include:
- Wasting or thinning of the muscles about the shoulder
- Pain when lifting the arm above shoulder level.
- Pain when lowering the arm from a fully raised position
- Weakness when lifting or rotating the arm
- Crepitus or clicking sensation when moving the shoulder in certain positions
- Some have inability to lifting the arm up
Symptoms of a rotator cuff tear may develop right away after a trauma, such as a lifting heavy weight or a fall on the affected arm. When the tear occurs with an injury, there may be sudden acute pain, a snapping sensation and an immediate weakness of the arm. Symptoms may also develop gradually with repetitive overhead activity or following long-term wear. Pain in the front of the shoulder radiates down the side of the arm. At first, the pain may be mild and only present with overhead activities, such as reaching or lifting. It may be relieved by over-the-counter medication such as paracetamol or combiflam.
Over time the pain may become noticeable at rest or without any activity at all. There may be pain when lying on the affected side and at night.
Diagnosis of a rotator cuff tear is based on the symptoms and physical examination. X-rays may be helpful but imaging studies, such as MRI (magnetic resonance imaging) or ultrasound, are more specific in showing the tear.
The doctor will examine the shoulder to see whether it is tender in any area or whether there is a deformity. He will measure the range of motion of the shoulder in several different directions(forward,backward,sideways) and will test the strength/power of the arm musculature. The doctor will also check for instability or other problems with the shoulder joint.
Magnetic resonance image shows a full-thickness rotator cuff tear within the tendon. The doctor may also examine the neck to make sure that the pain is not coming from a ” pinched nerve ” in the cervical spine and to rule out other conditions, such as osteoarthritis or rheumatoid arthritis of cervical spine.
Plain X-rays of a shoulder with a rotator cuff tear are usually normal or show a small spur. For this reason, the doctor may order an additional study, such as an ultrasound or MRI. These can better visualize soft tissue structures such as the rotator cuff tendon.
An MRI specially with contrast also called MR-Arthrogram can sometimes tell how large the tear is, as well as its location within the tendon itself or where the tendon attaches to bone.
Diagnosis Frozen shoulder
A doctor can diagnose frozen shoulder based on the patient’s symptoms and a physical examination.
X-rays or MRI (magnetic resonance imaging) studies vary sometimes used to rule out other causes of shoulder stiffness and pain, such as a rotator cuff tear.