Shoulder Fiber Tear

All of the muscle groups that allow my shoulder to move 360 degrees are called cuff muscles. Rotator sheath (cuff) tears are a very common shoulder problem in adults.
Thousands of people consult a doctor every year because of this problem. A torn rotator cuff leads to weakness in the shoulder. This means that our daily activities, such as combing our hair, washing our head or putting on clothes, become painful and difficult.

Shoulder Anatomy

The shoulder is made up of three bones; the humerus (arm), scapula (shoulder blade) and clavicle (collarbone). The knob belonging to the humerus forms the shoulder joint with the socket belonging to the scapula.

This joint is surrounded by the tendons of the muscles we call the rotator cuff. The rotator cuff consists of 4 main muscles. These muscles allow the arm to lift up and rotate.

There is a sac in the shoulder called the bursa, which acts as a cushion. It is located between the acromion belonging to the scapula and the supraspinatus tendon from the rotator cuff muscles. This structure allows the supraspinatus tendon under the acromion to rub against the bone and slide freely. In inflammation or damage of this sac called the bursa, shoulder movements become painful.

How does a shoulder tear occur?

The cuff muscles begin to tear at or near where they attach to the upper part of the arm bone, before beginning to fray and, as the condition progresses, develop into partial or full-thickness tears.

There are two main causes; injury and degenerative

Acute Tear

It can be torn suddenly by falling directly on the arm or lifting something heavy. Such tears can be accompanied by collarbone fractures or shoulder joint dislocation.

Degenerative Tears
It is a condition that develops slowly over time and involves thinning and tearing of the rotator tendons. This degeneration is associated with aging. Rotator cuff tears most commonly occur in the dominant arm and even if you do not have pain, the other shoulder is at risk.

There are many causes of degenerative tears;
• Frequent use: Sports such as tennis, volleyball and weightlifting that cause stress on the shoulder and frequent
may be due to use. In many professions, this can be an occupational disease.

• Decreased blood flow: With aging, the blood flow to the shoulder decreases and the tissue
quality goes down.

• Bone spurs: Inclined growth or protrusion of the acromion from the shoulder bones
If it comes in, it can rub against the rotator cuff, causing it to tear.

Who is at risk for shoulder tears?
These tears are most common after the age of 40 and aging is a risk factor. In certain professions and sporting activities, tears may occur due to frequent use of the shoulder (carpet weavers, wall painters or in volleyball, tennis sports, etc.).

What are the symptoms of shoulder tears?
The most common cause of rotator cuff tears

•Shoulder pain that does not go away at night and at rest;
•Increased shoulder pain when lifting the arm upwards
•Weakness in lifting and turning the arm around its axis
• Reception of friction sounds in the shoulder joint in certain positions

If the tear occurs suddenly, such as in a fall, there will be severe shoulder pain. There may be a feeling of jumping when lifting the arm.
In slowly developing degenerative tears, there may be shoulder pain and weakness in the arm. It is meaningful to have increased pain in the shoulder when you raise your arm sideways towards the other shoulder. Initially, shoulder pain may be mild and should not be considered a part of life.

Over time, the pain can become unbearable and does not go away with rest. There is no response to medication and it can wake you up at night. Simple daily activities, such as combing hair and putting on clothes, can become painful.

Physician Examination
During the examination, the range of motion of your shoulder joint, muscle strength and pain provoking tests are performed.

Imaging

X-rays are taken and bone structures are evaluated. Bone changes such as type 2-3 acromion bone protrusion, acromion arm knob distance etc. are evaluated.
MRI shows changes in soft tissues. It is extremely important in terms of giving detailed information about the size of the tear, edema, etc.

Treatment for Shoulder Fiber / Muscle Tear

If you have a rotator cuff tear, there is usually an increase in pain as you continue to use the shoulder.
This is related to the progression of the tear over time.
Chronic shoulder and arm pain is an important reason to see a doctor. Early diagnosis and treatment are important for a successful outcome.
The main goal of treatment is to relieve pain and restore shoulder function.
There are many different treatment methods for these tears and these methods vary according to the individual. The planning of your treatment is influenced by age, activity level, type of tear, general health status, etc.

There are surgical and non-surgical treatment methods depending on the patient’s condition;

There are surgical and non-surgical treatment methods depending on the patient’s condition;

Non-surgical treatment (non-surgical treatments)
Some patients benefit from non-surgical methods;

• Resting Inability to raise the arm above shoulder level and resting with an arm sling

• Activity Modification: avoid movements that cause pain
• PRP; briefly, it is the injection of blood flake cells prepared with blood taken from you into the problematic area. For details, see the section on non-surgical treatments

• Medication: Non-steroidal drugs, muscle relaxants
•Physical Therapy
• Local injection: In case of no response to the above conditions, steroid injection with local anesthetic is given.

Surgical Treatment
Persistent pain is the main indication for surgery. Surgery may be recommended if you are very active or use your arm a lot professionally.
Surgery should be considered in the following cases;
• If you have had pain for at least 6 months,

• If the rotator cuff tear is large,

• If there is weakness and loss of function in the shoulder,
• If it wakes you up at night,

• Acute tears caused by severe trauma.
There are many different repair methods within surgical methods.