Although there are many reasons for shoulder pain, a common problem for people over 40 years of age is a rotator cuff tear. The rotator cuff is comprised of the muscles and tendons that surround the top of the upper arm bone - the humerus -- and hold it in the shoulder joint. A sudden tear may result from a single traumatic event or develop gradually because of repetitive overhead activities. A partial tear may cause pain when the arm is lifted in a certain arc away from the body (painful arc syndrome) and a complete tear may limit the aility to raise the arm.
Signs and symptoms of rotator cuff tears are:
Recurrent, constant pain, particularly with overhead activities.
Pain at night that prevents you from sleeping on the affected side.
Muscle weakness, especially when attempting to lift the arm.
Catching and grating or cracking sounds when the arm is moved.
Limited motion.
Usually occurs in the dominant arm, which is the right shoulder for right-handed people; left shoulder for left-handed people.
May be triggered by a specific incident.
Diagnosis
Diagnosis is made through taking a patient's medical history, performing a physical examination and taking X-rays.
Treatment
In most cases, the initial treatment involves:
Rest. If the tear is due in part to overuse, resting the shoulder may help.
Nonsteroidal anti-inflammatory medications will help control pain.
Strengthening and stretching exercises, as part of a physical therapy program, are recommended.
Corticosteroid injections can help reduce pain but cannot be repeated frequently because they can also weaken the tendon.
Ultrasound can enhance the delivery of topically applied drugs and has thermal effects that may also help in the healing process.
There are several surgical options to treat rotator cuff tears, depending on the size, depth, and location of the tear. If other problems with the shoulder are discovered during the surgery, they will be corrected as well.
The three main options for surgical repair are:
"Open" surgery done through a five-inch incision on the front of the shoulder. The bone spur on the undersurface of the joint is removed and the cuff is attached to the upper arm bone using stitches and holes drilled in the bone.
"Mini-Open" repair using a two-inch incision.
Arthroscopic done using small instruments through several small Band-Aid size incisions. "Bone anchors" are placed in the upper arm bone and used to help attached the cuff with stitches. The anchors are made of either metal, plastic or a special material that your body absorbs over time.
