Rotator Cuff Injury - Torn Rotator Cuff

The rotator cuff of the shoulder is actually a composite of four major muscles that work in harmony to move the shoulder through a magnificent array of movement possibilities, enabling humans to use the hand in a startling array of possibilities. The precise placement of the ligaments and muscles onto the upper long bone of the arm (humerus) enables the arm and hand to swivel and arc, as well as rotate on its long axis. The majesty of this mechanism almost cannot be overstated, and is generally not sufficiently well appreciated. Almost none of the sports at which we marvel could be performed without this engineering masterpiece.

Rotator cuff injuries are, for the most part, tendon injuries, where the tendons insert or connect to the bone. Partial tears may involve the muscle itself, but complete tears generally mean that the tendon attachments have been disrupted. The muscles swing over the shoulder and attach to the wing-bone of the back (scapula). Other crucial muscle-tendon attachments are to the collarbone and some of the bony side-projections of the upper spine. The brain, of course, coordinates the various muscle tensions necessary to make the arm move when and where it is wanted.  

Cause of Rotator Cuff Tear

The most common cause of a torn rotator cuff injury in a young person is a fall onto an outstretched hand or a direct hit to the shoulder in something like a side-impact car accident or being speared by a helmet of an opposing player in football, for example. The pain is typically severe, although localizing the exact spot of the pain is often problematic for the patient. She only knows that the pain is severe and the arm is nearly useless. The majority of cuff injuries occur in older people, since the tendons wear thin with age, and are more easily prone to breakage with stress. Some patients, especially older ones, may tear the rotator cuff with repetitive movements, such as stocking shelves overhead, for example. A common complaint is that one is unable to open cabinets overhead, or even comb her hair.

Treating Torn Rotator Cuff Injury

Many older patients are happy to treat their torn rotator cuffs conservatively, with anti-inflammatory medicines and physical therapy to strengthen the intact muscles of the shoulder. For many, injections of steroids directly into the area of pain affords relief from pain for weeks. For younger patients the need for surgery is generally imperative, since the long-term disability of a bad shoulder is too great to bear, especially with the dominant arm. The MRI is the most commonly used diagnostic tool in determining that a tear has occurred. In the hands of some technicians, ultrasound can be nearly as good. Injection of dye into the shoulder joint to make a diagnosis has largely, if not completely, been abandoned. Surgery can involve large incisions, which make it easier for the surgeon, or smaller incisions, which require the use of scopes and cameras to hook things back where they belong. In some older patients, the spurring of the bones that may develop with age makes the larger incision nearly a necessity, and this only for those who have intractable pain or nearly complete disuse of the arm, unresponsive to conservative treatment. Even in younger patients, healing often requires six months or more. A gentle physical therapy routine is increased progressively over these months, to strengthen the shoulder. One must be careful not to push the limits in the early months. A properly diagnosed and repaired rotator cuff in a younger person will typically heal perfectly, restoring complete and normal use of the arm. Significant delays in accurate diagnosis may make complete repair impossible, since the tendons and muscles may atrophy with time. The younger the patient, the more important that one be aggressive in diagnosis and repair.  

Contact a Lawyer About Torn Rotator Cuff Injury

If you have suffered a torn rotator cuff as a result of a car accident, or negligence of others, Parker Scheer recommends that you consult with a personal injury lawyer and evaluate your case. For your free confidential case review click here and receive a response from one of our attorneys within hours. If you prefer, you can also telephone our offices in Boston seven days a week at toll free 866-414-0400.

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