Rotator Cuff Tears

Introduction

Rotator cuff tears are a common shoulder injury, particularly in occupations involving repetitive motion, heavy lifting, or sudden trauma. The rotator cuff is a group of four muscles and their tendons that surround the shoulder joint, providing stability and enabling a wide range of motion. When these tendons are damaged, it can significantly impact a person's ability to work and perform daily activities.

What is the Rotator Cuff?

The rotator cuff consists of four muscles:

• Supraspinatus: Helps lift the arm away from the body
• Infraspinatus: Assists in external rotation of the arm
• Teres Minor: Also helps with external rotation
• Subscapularis: Enables internal rotation of the arm

These muscles work together to stabilize the shoulder joint and allow for smooth, coordinated movement.

Causes of Rotator Cuff Tears

Work-Related Causes

Many rotator cuff tears are work-related, particularly in occupations that involve:

• Repetitive overhead activities (painting, construction work)
• Heavy lifting and carrying
• Sudden forceful movements
• Falls or direct trauma to the shoulder
• Prolonged awkward positioning

Degenerative Changes

Age-related wear and tear can weaken the rotator cuff tendons over time, making them more susceptible to injury. This is particularly common in workers over 40 who have performed repetitive shoulder activities throughout their careers.

Symptoms of Rotator Cuff Tears

Common symptoms include:

• Pain, especially at night or when lying on the affected shoulder
• Weakness when lifting or rotating the arm
• Limited range of motion
• Crackling sensation when moving the shoulder
• Difficulty reaching behind the back or overhead
• Muscle atrophy in severe cases

Types of Rotator Cuff Tears

Partial Tears

The tendon is damaged but not completely severed. These may be treated conservatively with physical therapy and anti-inflammatory medications.

Full-Thickness Tears

The tendon is completely torn, creating a hole in the tendon. These typically require surgical repair, especially in younger, active workers.

Diagnosis

Diagnosis typically involves:

• Physical examination and medical history
• X-rays to rule out bone abnormalities
• MRI to visualize soft tissue damage
• Ultrasound for dynamic assessment

Treatment Options

Conservative Treatment

For partial tears or older patients with lower activity demands:

• Rest and activity modification
• Physical therapy to strengthen surrounding muscles
• Anti-inflammatory medications
• Corticosteroid injections

Surgical Treatment

Surgery may be recommended for:

• Full-thickness tears in active individuals
• Tears that don't respond to conservative treatment
• Workers who need to return to demanding physical jobs

Surgical options include:

• Arthroscopic Repair: Minimally invasive technique using small incisions
• Open Repair: Traditional approach for large or complex tears
• Tendon Transfer: For irreparable tears, using nearby tendons

Workers' Compensation and Rotator Cuff Tears

Rotator cuff tears are commonly covered under workers' compensation when they result from:

• Specific workplace incidents
• Repetitive work activities over time
• Aggravation of pre-existing conditions due to work

Recovery and Rehabilitation

Conservative Treatment Recovery

Recovery time varies but typically takes 6-12 weeks with proper physical therapy and activity modification.

Surgical Recovery

Post-surgical recovery involves:

• Weeks 0-6: Immobilization in a sling, gentle passive motion
• Weeks 6-12: Active range of motion exercises
• Weeks 12-16: Strengthening exercises
• Months 4-6: Return to full activities and work

Prevention

Workplace injury prevention strategies include:

• Proper lifting techniques
• Regular breaks during repetitive activities
• Strengthening exercises for shoulder muscles
• Ergonomic workplace modifications
• Use of proper equipment and tools

Prognosis

With appropriate treatment, most patients with rotator cuff tears can return to their previous level of function. Factors affecting prognosis include:

• Size and location of the tear
• Patient age and activity level
• Quality of the tendon tissue
• Compliance with rehabilitation

Conclusion

Rotator cuff tears are a significant cause of shoulder pain and disability, particularly in the working population. Early diagnosis and appropriate treatment, whether conservative or surgical, can lead to excellent outcomes and successful return to work. For work-related injuries, workers' compensation provides essential support throughout the treatment and recovery process.