Shoulder pain – Rotator Cuff Tear (RC tear) and painful ark syndrome

Prof (Dr) Ujjwal K Debnath, MS(Orth), FRCSGlas, FRCS (Tr & Orth), DM (Orth), CCT-UK (Tr & Orth) Consultant Orthopaedic Surgeon
You can’t always feel a torn rotator cuff. But in some cases, you might:
• Have trouble raising your arm
• Feel pain when you move your arm in certain ways or lie on it
• Have weakness in your shoulder
• Be unable to lift things like
• Hear clicking or popping when you move your arm

Your risk of this goes up with:
• Occupation. Jobs like building workers or sports persons has higher chance of RC tears.
• Lack of blood supply. As you get older, you get less blood to your rotator cuff area, which makes small tears hard to repair, leading to larger tears.
• Bone spurs. Bone overgrowth in the shoulder can wear away the rotator cuff tissues and cause tears. 
• Age. Rotator cuff tears are most common in people over 60.
• Family history. They happen more often in certain families.
• Athletics. Playing Tennis, rowing, and weightlifting may stress your RC causing tears. 
• Trauma. Acute falls may lead to shoulder dislocations and RC tears.

Diagnosis

Docto needs to examine the patient for diagnosis. During the exam, they’ll check your range of motion and muscle strength. They’ll also see what movements make your shoulder hurt.
In addition, your doctor may use one of the following imaging techniques:
• MRI, makes detailed pictures of your shoulder.
• X-rays to see if the acromion bone is pushing into your rotator cuff space.
• Ultrasound to see the soft tissues (tendons, muscles, and the bursas) in your shoulder.

Complications

If you don’t treat your rotator cuff tear, you may experience weakness, or you could lose the ability to move your shoulder permanently. Your shoulder joint may deteriorate too. 

Treatment

Your doctor is likely to start with a combination of several treatments including:
• Physical therapy to make your shoulder muscles stronger
• Medications like anti-inflammatory drugs to help with pain and swelling
• You also may get exercises to do at home more comfortable ways in your day-to-day life.
• Rest to allow your rotator cuff to heal
• Steroid injections into your shoulder joint, which can provide temporary pain relief
If those don’t work, you may need surgery, especially if you have a complete tear. Its likely that your Orthopaedic doctor will need to stitch together the torn area or reattach the tendon to the bone.
Types of rotator cuff surgery:
• Arthroscopic. Your doctor will make a small cut (Key hole) in your shoulder then use an arthroscope — a tube with a small camera and tiny instruments — to fix the tear. This means your recovery time will likely be shorter than it would with another type of surgery.
• Open. Your doctor uses larger instruments to go into the muscles of your shoulder and fix the tear.
• Mini-Open. This uses both arthroscopic and open methods. Your doctor starts with the arthroscope and finishes with larger instruments.