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DISCUSSION:

AETIOLOGY AND SYMPTOMS:

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Rotator cuff tear is the most prevalently occurring tear in our body . It may leads to different consequences. Many studies says that rotator cuff tear is common in males than females .But now recent studies prove that it is common for both males and females. It’s is actually due to the continuous usage or movement of shoulder in the same direction for a prolonged period. Prior treatment is necessary to stop this in the initial stage itself . Many tear might occur due to trauma.

The consequences varies from person to person. Symptoms are different for those in young people, adolescents and older people. Not all people are suspected , but people who have excessive hand work are suffered the most. The pain is gradual and sudden onset of pulling of muscles. Rotator cuff injuries are commonly associated with motions that require repeated against full motions or forceful pulling motions. Such injuries are frequently sustained by athletes whose actions include making repetitive throws, athletes such as weightlifters, boxers, baseball or hockey players etc. Recent studies says that rotator cuff tear is also occurring in persons who are drummers, swimmers, fast bowlers , martial artists who are continually giving strain to rotator cuff tendons.

Some articles reveal that the symptoms of rotator cuff tear is almost same from person to person. Since the pain depends upon the size of the tear and how much the rotator cuff is actually torn. The pain at first appears only in the shoulder and gradually reaches along the side of the shoulder and reaching up while turning the steering of the car wheel or pain while sleeping. Most patients  have severe pain only while sleeping at night. They find it difficult to sleep on one side by pressing the affected shoulder.

Traumatic rotator cuff tear is another case. In this the active surgeons favour early rotator surgery for larger traumatic rotator cuff injury. The person feel weakness , acute pain and if left untreated the size of the tear may increase and cause complications . This is because the tissue is most likely normal prior to trauma and so the surgeons expect the surgery results should be good with regards to improved strength , range of motion and pain elimination.

Tendon degeneration is also the common aetiology among older people where the tendon is degenerated completely losing its sac and have difficulty in free gliding of shoulder. It’s due to aging. Repetitive stress is the most significant factor. The tear might occur due to the gradual decrease of blood supply to the tendons which is more prominent in older populations.

Another main aetiology is impingement Syndrome. It is the factor among non-sports related injury. In this tendons of the rotator cuff rub on the underside of the acromian. This happens while elevating the arm upwards , the space between the tendon and the shoulder is narrowed. And hence the bursa is inflamed leading to damage. Recent studies says that spurs might develop that can actually damage the tendon to such an extent that the tendon becomes eroded away and tear. It is of primary tendonitis and secondary impingement.

DIAGNOSIS:

 The diagnostic methods is also advanced. In case of normal pain mostly physical therapies are recommended. Only if the pain increases or accurate ,Magnetic resonance imaging  is used. An MRI will be helpful to see if the weakness is secondary to pain or an actual tear. 

Rotator cuff fatty infiltration is also discussed mainly in some articles. In this if the rotator cuff is torn for a long time , the muscle which is torn might turn into fat. Fat is not like muscle tissue , this may not allow the surgery to be successful leading to dis improvement of function. And even after the surgery the fat will never  turn into a muscle tissue. Now MRI scanning is useful to determine the degree of fatty infiltration in rotator cuff.

Ultrasound is used to diagnose both partial and full thickness tear. But however studies confirm that MRI is the best method for diagnosing partial thickness rotator tear. Ultra sound has 90% sensitivity and specificity. Ultrasound is used in case of higher tear and helpful in dynamic testing , assessing the affected shoulder and the healthy shoulder.

X-rays don’t show up that clear in rotator cuff. Recent studies says that it helps in the diagnosis of bone spurs. This one is normally used in case of acute tears showing degenerative type changes.

TREATMENT:

Rotator cuff tears are one of the most common shoulder problems that usually require operative treatments. Therapeutic options used to repair ruptured tendons have consisted of suture, autografts, allografts (transplants), and synthetic prostheses.
Although surgical treatments have improved dramatically up to now, shoulder pathology is still challenging to orthopaedic surgery primarily because these injuries often respond poorly to treatment and require prolonged rehabilitation.
Recent attention has focused on several biologic pathways which can augment function to tendon healing, consequently leading to the identification of growth factors involved in this process.

The treatment varies from person to person based on the size or type of the tear. Recent studies says that rotator cuff tears are linked to a reduction in the natural number of functional stem cells in the tissue. And hence sometimes tear can heal on its own. In a recent analysis over 24 patients who has complete thickness tears where left untreated for some periods. In this out of 24 ,  2 patients the tear healed on its own . In 9 of 24 the tear was smaller. In another 9 out of 24 patients the rotator cuff tear size  didn’t change. In 6 patients , tear was found to be bigger. Since 75% of the patients, the tear was either healed ,smaller or didn’t change.

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