Rotator Cuff Tear
It's one of the darkest fears of pitchers, tennis players, and many other athletes: a rotator cuff tear. If it is severe, a rotator cuff tear can end a player's career. So what is it, exactly?
The rotator cuff is a group of four tendons and muscles that converge around the shoulder joint at the top of the humerus, the upper arm bone above the elbow. Together, they form a ''cuff'' that both holds your arm in place and allows it to move in different directions. While your shoulder is one of your most mobile joints, it's also somewhat weak. Too much stress -- or too many fastballs -- can cause partial tears and swelling in the tendons of the rotator cuff. Abrupt stress may even cause one of the tendons to pull away from the bone or tear in the middle of the tendon. Rotator cuff tears are sometimes incorrectly called ''rotary cuff tears.''
Athletes prone to getting rotator cuff tears include:
- Baseball players, especially pitchers
- Tennis players
- Football players
You can get a rotator cuff tear by
- Falling on your shoulder
- Using an arm to break a fall
- Lifting heavy weights
The symptoms of a rotator cuff tear include:
- Pain in the shoulder and arm, which varies depending on how serious the tear is
- Weakness and tenderness in the shoulder
- Difficulty moving the shoulder, especially when trying to lift your arm above your head
- Snapping or crackling sounds when moving the shoulder
- Inability to sleep on the shoulder
Most rotator cuff tears develop gradually. But they also can happen suddenly -- you might feel a pop, intense pain, and weakness in the arm.
To diagnose a rotator cuff tear, your doctor will give you a thorough physical exam. He or she will want you to move your arm in different directions to see what causes pain. In addition, your doctor might want to order the following tests:
- X-ray of the shoulder with some special views
- MRI (Magnetic Resonance Imaging)
- Arthrogram, a special type of X-ray or MRI done after a dye is injected into joint; this will allow your doctor to see more detail.
- Arthroscopy, a minimally invasive surgical procedure in which a tiny camera is inserted into the shoulder joint to get a look at the rotator cuff Arthroscopy is usually not done unless it is likely that you will need a surgical repair based on the other non-surgical tests.
These tests will allow your doctor to rule out other conditions and confirm that you have a rotator cuff tear. He or she may refer you to an orthopedic surgeon for treatment.
As bad as these injuries can be, the good news is that many rotator cuff tears heal on their own. You just need to give them a little time. You also should:
- Rest the joint as much as possible. Avoid any movement or activity that hurts. You may need a sling.
- Ice your shoulder two to three times a day to reduce pain and swelling.
- Perform range-of-motion exercises, if your doctor recommends them.
- Consider physical therapy to strengthen the joint.
- Use anti-inflammatory painkillers, or NSAIDS, like Advil, Aleve, or Motrin. However, these drugs can have side effects, like an increased risk of bleeding and ulcers. They should be used only occasionally, unless your doctor specifically says otherwise.
More serious rotator cuff tears require surgery. One procedure is shoulder arthroscopy, usually an outpatient procedure. During an arthroscopy, the patient is put to sleep with general anesthesia. A small camera is inserted into the shoulder to see and repair the rotator cuff tear. If the tear is very large or involves more than one tendon, a small incision may be needed. Following arthroscopy, the arm will likely be in a sling for two to three weeks and physical therapy will be prescribed.
What a lot of athletes really want to know is when they can get back in the game after a rotator cuff tear. But it's hard to say. Recovery time depends on how serious the tear is. It may take weeks or months. People heal at different rates. Obviously, if you need surgery, recovery will take longer.
But whatever you do, don't rush things. Do not resume the activity that caused your injury until:
- You feel no pain in your shoulder
- Your shoulder feels as strong as the uninjured one
- You have almost normal range of motion
- You can sleep on the shoulder
- You can function as well as before the injury
If you start using your shoulder before it's healed, you could cause permanent damage.
Athletes should ease back into their sport. For instance, if you got a rotator cuff tear from throwing, don't start off by pitching fastballs. Do more gentle tossing until you get your strength back.
The best way to prevent future rotator cuff tears is to keep your shoulder muscles strong. Talk to your doctor or physical therapist about exercises that will help.