The rotator cuff is one of the most important stabilizing musculoskeletal regions. Because it is responsible for stabilizing the shoulder joint, it gets a lot of use, which can lead to injury. Those Rotator cuff tears vary in severity, from a mild inconvenience to a debilitating injury. The treatments vary with the severity, and there is new research suggesting that stem cell therapy may be very useful.
What is the rotator cuff?
The rotator cuff is made up of the tendons of 4 muscles. Those muscles are the supraspinatus, infraspinatus, teres minor, and subscapularis. These muscles insert on the humerus, the upper bone of the arm. They stabilize shoulder motion. An injury is defined as either an issue in one of the tendons or a tear in the muscles. The tear can be partial or full, meaning it goes all the way through.
What risk factors increase the risk for injury?
Certain factors put people at increased risk for rotator cuff tear. In one study, patients over the age of 60 were found to be twice as likely to develop larger tears. In fact, rotator cuff tears were found in 62% of people older than 80 years old. Gender may also change the risk. In one study, women who had already gone through menopause were more likely to have a full thickness tear. However, those results have not been repeated, and other studies found that
both men and women were equally as likely to have tears. Smoking is another factor that affects rotator cuff tears. In fact, one study found that, of the patients with shoulder pain, 61.9% had a smoking history. They found that the amount of cigarettes smoked per day and the longevity of their smoking history increases the risk of tears. Interestingly, posture is another major factor. People who slumped were more likely to have a tear than those with ideal posture.
How can it be injured?
As stated above, an injury can happen in any of the tendons or muscles that compose the rotator cuff. These injuries can happen suddenly or over time. A common sudden injury is when someone undergoes a trauma and they have an avulsion. An avulsion is when one of the tendons is suddenly snapped away from the bone and a small part of the bone is snapped away with it. Cuff injuries may also develop over time. These happen with repetitive motions. For example, people who play tennis are more likely to develop a rotator cuff tear in their dominant hand. Additionally, the tendon may weaken over time due to degenerative changes in the joint.
What are the symptoms?
Typically, people with rotator cuff injuries have shoulder pain on the affected side. This pain may be worse with sleeping on that side or reaching overhead. People generally complain that they are not able to use that shoulder as they used to. However, in other cases, some people do not have any symptoms. This usually occurs with smaller tears and earlier in the course.
How is it diagnosed?
There are certain physical exams that doctors will do that indicate rotator cuff injury. There are three different maneuvers: Hawkins impingement test, Neer impingement test, and empty can test. Pain with any of these maneuvers can indicate a rotator cuff injury. However, there are some other conditions, like biceps tendinopathy or arthritis, that may mimic rotator cuff injuries. In cases where the diagnosis is unclear, physicians may turn to radiographic imaging. Often, they will start with an x-ray. X-rays generally only show bones. In a rotator cuff injury, many times there are not any bony changes. In those instances, physicians will turn to Magnetic Resonance Imaging (MRI). MRIs show all soft tissue. Doctors can see where the injury is. However, MRIs are very expensive and not always necessary. The doctor will discuss the best diagnostic options with the patient.
What is the treatment?
There are multiple ways to approach treating rotator cuff injuries. They are generally divided into two categories: surgery or nonsurgical management. The benefits of non-operative management include avoiding surgery and its possible complications. Nonsurgical management includes physical therapy, pain control, and steroid injections. However, the issue with nonsurgical management is that many people develop degenerative changes in the joint.
Surgical options in order of escalation include partial repair or debridement, open or arthroscopic repair, or full reconstruction or arthroplasty. A partial repair or debridement means the surgeon just removes the damaged portions of the joint. An arthroscopic repair refers to small cameras that allow the surgeon to repair the cuff without making a large scar. An open repair requires a large incision and does not use cameras. Lastly, a full reconstruction means that surgeon has to completely redo the joint.
There is emerging evidence that stem cell injections may be beneficial with rotator cuff injuries. Stem cells avoid the complications of surgery, but may be more beneficial than nonsurgical management. More on this topic will explored in the following article.
How do I learn more?
At the Stem Cell Transplant Institute, we believe in delivering care according to the latest scientific research findings. If you would like to learn more about how stem cell therapy can help you reach your goals, contact us today.