The rotator cuff is one of the most important muscle groups present around the shoulder joint. It is the responsibility of this group to keep the humerus (upper arm bone) intact in the joint while moving the arm. As there is such a major task for this muscle group to handle, it is at high risk of getting injured resulting in rotator cuff tears. In such a situation, one must visit a shoulder specialist and get it treated in time. The treatment approach depends on the severity and type of injury. Let’s discuss the different types of rotator cuff tears and understand this shoulder problem in depth.
Rotator cuff- the anatomy
The rotator cuff comprises 4 different muscle-tendon units. These muscles originate from the shoulder blade and insert onto the arm bone. These muscles are:
- Supraspinatus: This muscle is responsible to facilitate the first 15 degrees of raising the arm and later on the other muscles (deltoid and trapezius) takes over the responsibility of the movement.
- Infraspinatus: This muscle helps in the external rotation of the arm (lateral aspect). It along with the subscapularis also helps in centralizing the shoulder joint.
- Teres Minor: It is located just below the Infraspinatus and helps in the external rotation of the arm (lateral aspect).
- Subscapularis: It is the strongest rotator cuff muscle and contributes to all types of shoulder movements. It connects the arm bone from the front.
The rotator cuff may give way at the following sites
(this classification is only meant for patient awareness)
- Type A: This type of tear involves bone avulsion or tear of the tendon at the insertion site
- Type B: Tendon bulk is involved in the tear
- Type C: This type includes the involvement of the muscles
- Type D: This type of rotator cuff dysfunction is caused due to muscle insufficiency
Type A Rotator Cuff tear
Although tendon or muscle is included in such a shoulder problem, the involvement of bone is also considered while planning the treatment process. Due to fractures, nonunion, or bone insufficiency, this shoulder problem can become more complicated and falls under this category. It can be further classified as A1, A2.
A1 covers acute bony involvement and arthroscopic approach or traditional methods are used to treat such injuries.
A2 indicates tuberosity nonunion that is generally a consequence of the failed treatment of A1 as the displacement of fracture may affect the length of the tendon and affects the functionality of the rotator cuff. For the treatment of such nonunion of proximal upper arm bone fracture, there are many surgical techniques. The selection of the treatment procedure depends on many factors like age, associated risks, etc.
Type B Rotator Cuff tear
This type of rotator cuff tear involves an injury in the tendon and be further divided into 4 grades- B1, B2, B3, and B4. The size of the tear plays a crucial role and the tear pattern is identified with the help of the involved components (muscles) of the rotator cuff. The tear patterns are:
- Type A: Supraspinatus & superior subscapularis tear
- Type B: Supraspinatus & complete subscapularis tear
- Type C: Supraspinatus, superior subscapularis, & infraspinatus tear
- Type D: Supraspinatus & infraspinatus tear
- Type E: supraspinatus, infraspinatus, and teres minor tear
B1 indicates a tear in the lateral section (tendon) of the muscle and B2 refers to a tendon tear that is medial to a lateral tendon (generally torn Supraspinatus connecting to infraspinatus). B3 signifies a Fosbury flop tear wherein prominent tendon flips and causes the gathering of fluids. This tendon further runs throughout the joint medially. B4 means tendon to acromion adhesion and is generally observed in the case of a major contracted rotator cuff tear.
Type C Rotator Cuff tear
This category includes rupture of musculotendinous intersection and can be observed in all 4 muscles present in the rotator cuff. There are different grades and define the intensity of the tear and these are:
- Grade 1: muscular strain without any complications if treated well
- Grade 2: partial tear without any tendon retraction
- Grade 3: complete musculotendinous tear
Type D Rotator Cuff tear
It refers to muscle insufficiency and be divided into many sub-categories. D1 symbolizes muscle atrophy or fatty infiltration due to the muscle weakness and if left untreated, then can affect several tendons at a single time. D2 deals with neurological impairment and develops due to a series of shoulder problems. Sometimes a cyst developing in the body affects the muscular tissue of the shoulder joint and hence it falls in the category of D3.
So these were the types of rotator cuff tear and each condition requires a unique treatment plan. Hence, you should get medical help as soon as possible. If you are looking for an experienced rotator cuff repair surgeon in Gurgaon, then you can book an appointment with Dr. Reetadyuti Mukhopadhyay. He tries his best to heal the shoulder problem as soon as possible by implementing the most effective treatment technique.