Is your shoulder hurting? It could be a rotator cuff tear!

Do you also have difficulty lifting or rotating your shoulder? Does it hurt when you do? Sometimes when you sleep at night, do you feel so much pain that you can't even put weight on your shoulder? Or do you feel like something is 'tucked' inside your shoulder, or it's getting stuck? Then this story will be very important to you. Today we are going to talk about a shoulder problem that many people have, but are not exactly aware of. That is a tear in the part of the shoulder called the rotator cuff .

What is the rotator cuff of the shoulder? How does it tear?

Simply put, the rotator cuff is a collection of four muscles and their tendons in your shoulder that form a small 'cuff' or bracelet around the shoulder joint.

Its main function is to help you raise, lower, and rotate your arm in and out . It also helps keep the ball-like part of your upper arm bone (which we call the humerus in medical terms) in its socket in the shoulder blade. Think of it like a golf ball on a golf tee. That's how our shoulder joint works. The rotator cuff helps keep the ball from bouncing off the tee.

So, a rotator cuff tear is when one or more of those tendons completely or partially detach from the upper arm bone (humerus). This can happen suddenly (such as a fall), or it can happen over time as the tendon wears down over time.

Are there any types of these tears?

Yes, there are mainly two types:

1. Partial Tear: This is when the tendon does not completely detach from the bone. This means that the tendon is still attached to the bone to some extent. But it is slightly torn and weakened. It is like a piece of cloth that has torn slightly without completely tearing.

2. Complete Tear or Full-Thickness Tear: This is when the tendon completely separates from the bone. More specifically, the tendon appears to have a hole in it, or it completely breaks in two.

How common is this condition?

Rotator cuff tears are actually more common than you might think. They are especially common among older adults . According to some statistics, millions of people around the world suffer from this rotator cuff problem every year.

Just think, some people have this tear but don't have any symptoms, so they don't even know they have it! It can be so silent sometimes.

What are the symptoms? How do you feel about this?

The symptoms of a rotator cuff tear can vary from person to person, but there are some common symptoms:

• It is difficult, painful, and feels like there is no strength in the arm when raising, lowering, or rotating it.This pain may occur when you comb your hair, scratch your back, or reach up to pick something up.
• When I move my arm in a certain way , I hear a 'tick-tock' or 'chiri-chiri' sound coming from inside my shoulder, or I feel like something is twisting or getting stuck inside.
• Shoulder pain tends to get worse at night. The pain can be especially severe when sleeping on the injured side. Some people experience pain even when simply resting their arm on their side.
• Your shoulders are weak, making it difficult to lift things, open doors, etc. You may find it difficult to do things that were easy before.

What exactly does this pain feel like?

This is also different for each person. Some may feel a dull, constant ache that feels like something is stuck inside the shoulder, with a heaviness . Others may experience a sharp, stabbing pain .

• If the tear occurs in a sudden accident (acute tear) , such as a fall, then you may suddenly experience unbearable shoulder pain and complete loss of arm strength.
• In a degenerative tear , the pain may be mild at first. It may be relieved by over-the-counter pain relievers (OTC pain relievers). However, over time, the pain may become more severe and may not be relieved by the medication.
• The important thing is, not everyone will experience pain, but most people will definitely feel some weakness in their arms and shoulders.

Why is this happening? What are the reasons for this?

There are several possible causes of a rotator cuff tear.

1. Acute Injury:

A tendon can tear from a fall, a hard blow to the shoulder, or a sudden strain on the shoulder when lifting a heavy object. Sometimes, the rotator cuff can also be damaged when the shoulder is dislocated or the collarbone is broken.

2. Degenerative Tears:

This is the most common cause. This risk is especially high in people over the age of 40. There are several reasons why this may happen:

• Bone spurs: Some people develop small bone spurs (`(Bone spurs)`) on the top of their shoulder bone, where the tendon passes. When we raise our arm, these bone spurs rub against the tendon. This is called ``Shoulder Impingement``. When this continues to rub, like a rope rubbing against a rock, the tendon can weaken and tear.
• Decreased Blood Flow:As we age, the blood supply to the rotator cuff tendons decreases. When any part of our body is injured, a good blood supply is essential for it to heal. So, when this blood supply is not adequate, the tendon becomes weak, and even a small injury does not heal easily, and can gradually progress to a large tear.
• Overuse and Repetitive Motions:

Whether it's playing sports or doing your daily work, when you use your shoulder in the same way, it puts a lot of stress on the muscles and tendons. This can also weaken the tendon and tear it. Think of someone who constantly looks up while painting, someone who does carpentry work, or someone who constantly bowls fast bowling while playing cricket or volleyball. They are at higher risk.

Who is more likely to develop this? (Risk Factors)

In fact, anyone can get a rotator cuff tear. However, some people are at a slightly higher risk. See if these facts apply to you:

• Age: People over the age of 40 are at higher risk because tendon strength and flexibility decrease with age.
• Family history: If someone in your family (mother, father, siblings) has had shoulder problems, such as rotator cuff tears, you may also be at slightly higher risk.
• Smoking: People who smoke have slower tendon healing rates and may also weaken their tendons.
• Poor Posture: People who work on a computer, use their phones, or hunch their shoulders forward while standing or sitting can put unnecessary pressure on the shoulder joint.
• Certain jobs and sports: As mentioned earlier, people who perform repetitive shoulder movements are more likely to develop these degenerative tears. For example:
• Carpenters
• Painters
• Vehicle technicians
• People who engage in heavy lifting jobs
• Athletes: Especially those who play sports like baseball, softball, tennis, swimming, rowing. People who play sports like cricket (especially bowlers), volleyball, and badminton, which are popular in our country, are also at risk.

What happens if treatment is not given? (Complications)

This is a question that many people ask. It's not a good idea to think, "It's okay if it hurts a little, it will get better on its own ." Because, if left untreated, this rotator cuff tear can get worse.

• Even a small partial tear can develop into a complete tear with continued use of the shoulder.
• If there is a complete tear, you can go to the point where you can't even move or lift your arm.
• >If left untreated for a long time, you may develop chronic shoulder pain, become so weak that you cannot use the injured arm for everyday tasks, and develop other problems, such as arthritis in the shoulder joint.

How do you diagnose this exactly?

If you have shoulder pain or discomfort, the first thing you should do is see a doctor. He/she will ask you questions and examine you.

1. Physical Exam: The doctor will feel your shoulder and check for tenderness and swelling. He will then ask you to move your arm in different directions (range of motion) and check your arm strength. These tests can give a rough idea of ​​whether you have a rotator cuff problem.

2. Special tests (Imaging Tests): To confirm the diagnosis, these tests may also be performed:

• X-ray: This cannot directly show a torn tendon. However, it can check for things like bone spurs, arthritis, and other bone problems.
• MRI (Magnetic Resonance Imaging): This is the best test to look for rotator cuff tears. It can clearly show how much of the tendon is torn and what type of tear it is (partial or complete).
• Ultrasound Scan: This can also be used to check for things like tendon tears and swelling. It is a test that can be done faster and at a lower cost than an MRI.

What is the treatment for this?

The good news is that there are many treatments for a rotator cuff tear. Your doctor will determine the best treatment for you based on factors such as the nature of your tear, your age, and your activity level.

Treatment methods can be divided into two main categories:

1. Nonsurgical Options

This is important for many people: Rotator cuff tears do not heal completely (the tendon reattaches) without surgery. However, many people (especially those with partial tears or those who are older) can reduce pain, improve shoulder function, and return to a level where they can perform daily activities without surgery.

In fact, studies have shown that about eight out of ten people with partial tears can recover well with non-surgical treatment . However, it can take months, even years, for this condition to improve. You need to be patient with treatment.

What are these non-surgical treatments?

• Rest and Activity Modification:It is very important to rest your shoulder. You may need to stop or reduce activities or sports that are causing pain for a while. Your doctor may also recommend that you wear an arm sling for a few days.
• Pain Relievers: Your doctor may recommend medications from the group of pain relievers called NSAIDs (e.g., Ibuprofen, Diclofenac) to reduce pain and swelling.
• Physical Therapy: This is the most important part of non-surgical treatment. A qualified physical therapist will teach you strengthening exercises to strengthen your shoulder muscles and stretching exercises to increase your shoulder's range of motion. Doing these exercises correctly can help reduce pain and improve your shoulder function.
• Steroid Injections: If the pain and swelling are severe, your doctor may decide to give you a steroid injection (e.g., a cortisone shot) into your shoulder joint. While this may provide quick relief, it is only a temporary solution. It is not a good idea to keep taking these injections.

2. Surgical Options

Surgery is needed in the following cases:

• If you have a complete tear (especially if it is a large tear).
• Even if it's a partial tear, there's no improvement after 6-12 months of non-surgical treatment.
• If you are young, active, or if your job or sports activities rely heavily on your shoulders.
• If there is a major tear due to an acute injury.

Most rotator cuff surgeries are now done arthroscopically . This means that a small camera (arthroscope) and surgical instruments are inserted through several small incisions in the shoulder. This procedure involves less pain and faster healing because it does not involve a large incision. However, sometimes, if the tear is very large or complex, the surgeon may perform open surgery (a procedure that involves a slightly larger incision).

The main goal of surgery is to reattach the torn tendon to the bone. Sometimes, if there are any bone spurs, they are also removed.

• In the case of a partial tear , the surgeon may only need to cut away some of the threadlike, worn-out pieces of the torn tendon. This is called debridement .
• Some tears may be irreparable tears due to their size, how long the tear has been there, and the condition of the tendon. In such cases, alternative surgeries may need to be considered. For example, ``Reverse shoulder replacement`` (a special surgery to replace the shoulder joint) or ``Tendon transfer`` (a healthy tendon is brought in from another place and fixed).

This surgery is usually done on the same day or the next day (an `outpatient procedure` or short stay). However, it takes a long time to fully recover from this surgery, possibly a year or more.

How long does it take to recover? (Recovery Time)

This is something that many people ask with concern.

• Without surgery, it may take several months for pain to decrease and function to increase with physical therapy and other treatments.
• If you have surgery,
• After surgery, you will need to wear a sling for about 4 to 6 weeks to prevent movement of your arm. It is essential to rest your shoulder during this time.
• Then you need to start physical therapy . This is definitely something that needs to be done. You start with shoulder movements gradually, and then move on to strengthening exercises.
• Most people regain normal shoulder function and strength within 4 to 6 months of surgery and are able to perform daily activities.
• However, it can take 9, 12, or even 18 months to fully recover and return to activities like sports. It depends on the size of the tear, the type of surgery, your age, and how well you do with physical therapy.

What will happen after recovery? (Prognosis/Outlook)

Most people can recover well after a rotator cuff tear.

• Many people experience reduced pain and improved functional status with non-surgical treatments .
• With surgery, especially with modern techniques like arthroscopy, many people can regain good shoulder function.
• However, there is a small chance that the same tendon will re-tear. This risk is especially high if the first tear was very large, or if you are older or a smoker. If it re-tears and causes severe pain or loss of function, you may want to consider surgery again.

Can this be prevented from happening again? (Prevention)

Although it can't be completely prevented, there are things you can do to reduce your risk of developing a symptomatic rotator cuff tear:

• Keep your shoulder muscles strong and flexible. Do stretching and strengthening exercises regularly. Ask your doctor or physical therapist for advice on this.
• Maintain proper posture while working or playing sports.
• If you're doing the same movements over and over, take breaks in between. Don't overexert your shoulders.
• When lifting a load, lift it properly. Don't pull it all at once and just lift it with your shoulders.
• If you smoke, stop it.

When to Call Your Healthcare Provider?

If you have any of these symptoms, you should definitely see a doctor for advice:

• Shoulder and/or arm pain that has been present for several weeks.
• If the pain worsens at night and interferes with sleep.
• If there is redness, swelling, or severe pain when touched in the shoulder joint.
• If you experience sudden weakness in your shoulder or arm , especially after an accident.
• If shoulder pain and discomfort are affecting your daily activities to the point where you can't do your daily activities .

What questions should you ask the doctor?

When you go to see the doctor, don't hesitate to ask questions like these:

• How did I get this rotator cuff tear? What is the main cause in my case?
• What type of tear is my tear (partial, complete)? How big is it?
• What is the best treatment for me? Do I need surgery?
• How much improvement can I expect from non-surgical treatments?
• If I have surgery, what are the risks? How long will it take to recover?
• What can I do to prevent this kind of tearing from happening again?
• What activities should I avoid? What things can I do?
• Should I be aware of complications? What are the symptoms of those complications?

If you work a lot or are an athlete, a rotator cuff tear may take you away from your work or sports for a while. However, it doesn’t have to be the end of your career or your sports career. Talk to your doctor about the best treatment option for you – whether it’s non-surgical or surgical. Even if your shoulder is painful and weak for a while, it can heal with time, the right treatment, and your own efforts. Patience and following your doctor’s instructions are the key.

Take-Home Message

A rotator cuff tear is a common, but potentially serious, condition that can cause shoulder pain and weakness.

• Causes: Accidents, wear and tear with age, overuse of the shoulder, and the development of bone spurs.
• Symptoms: Shoulder pain (especially at night and when raising the arm), difficulty raising the arm, weakness, 'clicking' sound coming from the shoulder.
• Tests: Physical examination, X-ray, MRI or Ultrasound scan.
• Treatment: Rest, painkillers (NSAIDs), physical therapy, steroid injections, and surgery (such as arthroscopic surgery) if necessary.
• Most importantly: If you have persistent shoulder pain or discomfort , see a doctor. The sooner you recognize it and start treatment, the better your chances of recovery. Don't try to treat yourself! Your shoulder is worth it.

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