There are four small muscles around the shoulder, which control and stabilize the movements of shoulder joint. Dr Ashwani Maichand, a leading orthopedist, says that these muscles originate from scapula and get attached to the arm bone (Humerus). These muscles are known as Supraspinatus, Infraspinatus, Teres Minor and Subscapularis. This group of muscles is called rotator cuff.
Rotator cuff can be damaged/torn due to various reasons like direct injury, indirect injury, muscle degeneration, etc.
It happens when someone falls down or there is a direct trauma to the shoulder.
This type of injury occurs when the muscles strike against acromion (bone at the top of the shoulder), which usually happens when the distance between muscles and bone narrows (Impingement) or the acromion tilts down due to bad posture or there is an abnormal growth of the bone (Osteophyte).
According to Dr Ashwani Maichand, the muscle degeneration happens in diseases like diabetes, hypothyroidism or due to ageing process. It causes weakness to muscle fibers, leading them to tear, even during daily activities.
A patient suffering from cuff tear will have sudden and severe pain in the shoulder after lifting some weight or after exertion. He is not able to lift his arm above the head. In long standing cases, the pain disappears, but weakness remains. The patient will have night pain causing sleep disturbance but he may or may not have stiffness of the shoulder.
What to do
In acute pain one must apply ice pack, take pain killer tablets, keep the arm in a sling and consult a shoulder surgeon as soon as possible. Dr Maichand advises that a patient must not go for a massage, manipulation, steroid injection or physiotherapy before a proper diagnosis.
Treatment of rotator cuff tear depends on two factors. One is the size of the tear and other is the age of the patient. If the tear is very small and the patient is elderly with low expectations from the shoulder, the doctors treat conservatively (muscle strengthening and balancing exercises). If the tear is big and the patient is young with high expectations from the shoulder, doctors always repair it.
This procedure is done by arthroscopic technique. It means there is no cut or incision made on the shoulder. A small camera goes into the shoulder joint, which shows the structure of the joint on a big screen. Guided by the camera, the torn muscles are stitched back to the bone using biodegradable sutures (Anchors). It’s a daycare procedure and patient is discharged the next morning.
After the procedure, the patient has to follow a supervised physiotherapy regime for six to eight weeks. According to, Dr Ashwani Maichand, there are certain precautions and restrictions for the same period. Patients can start their normal activities after six weeks, but sports activities can be started only after three months.