Yasmin Dhar, M.D.
Orthopedic Surgeon and Sports Medicine Specialist
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Rotator Cuff Tears
What is the rotator cuff?
The rotator cuff is the tendon portion of four muscles, which extend out from the shoulder blade (scapula) and insert at the upper portion of the arm (humerus) to form a “cuff” around the shoulder. The muscles that make up the rotator cuff are the supraspinatus, subscapularis, infraspinatus and teres minor.
The four muscles and their tendons together are named the rotator cuff because one of their important functions is to rotate the arm inward and outward. Perhaps more importantly, these muscles are responsible for stabilizing the ball of the upper arm (humeral head) in the very shallow socket of the shoulder blade (glenoid). The rotator cuff works especially hard to stabilize the shoulder when the arm is in the overhead position. This is why the overhead or reaching out position usually causes pain in someone with a rotator cuff injury.
What are the different types of rotator cuff injury?
Several injuries can happen to the rotator cuff. It is typically the tendon, the portion that attaches the actual muscles to the bone, which is usually injured. Most rotator cuff injuries usually result in tendonitis, which is inflammation of the tendon from being over-worked or irritated. Also, the tendon may be pinched between the bones in the shoulder and become inflamed. This is termed shoulder impingement syndrome.
Sometimes tendonitis progresses to the point where the tendon becomes frayed or torn. Tears of the rotator cuff are classified as partial thickness or full thickness. Partial tears extend only part way through the tendon while full tears extend all the way through the tendon.
How is the rotator cuff injuried?
The rotator cuff can be injured in an accident or fall (traumatic cuff tear). It is more common for the rotator cuff tendons to wear and weaken slowly until they finally tear (degenerative cuff tear). While rotator cuff tears can happen in anyone, they occur more often as people age and are more common in people who play sports or work with their arms overhead.
How do I know if I injuried my rotator cuff?
Many shoulder injuries can cause pain in the shoulder or upper arm. Many times rotator cuff pain is worse at night when you lay on your shoulder or flat. Sometimes when the rotator cuff is fully torn, you may also develop weakness. You may be unable to lift objects or you may have pain while doing so. You may not even be able to lift the weight of your arm. Everyday activities that require you to put your arm in the extremes of motion, like dressing, raising your hand or lifting a heavy object overhead and reaching outward to pull a heavy item, may cause pain and you may not be able to do them.
Do I need X-rays, MRI or any other tests?
If a torn rotator cuff is suspected, a set of X-Rays may be ordered. X-Rays show the structures of the bone. The bone above the rotator cuff (the acromion) can be misshapen or have bone spurs on it. Either of these conditions can make the bone rub on the rotator cuff. X-rays can also help determine if arthritis is present in the joint. A MRI may be ordered if a rotator cuff tear is suspected or if you are not responding to conservative care.
What treatment options are available for rotator cuff injuries?
Many patients with an injured rotator cuff, even a full thickness tear, may improve with conservative treatment. The first steps in treatment include physical therapy, use of oral anti-inflammatory medications, and possible a cortisone injection for pain relief. Studies demonstrate that many people will get better or significantly improve with this regimen of treatment so they can avoid surgery.
It is important to know that nonsurgical treatment will not result in healing of the tear, and the tear may become larger with time, so it is important to be monitored closely over time to ensure your symptoms improve.
In certain cases surgery may be the best treatment choice. When the patient has unbearable pain, night pain, weakness or loss of function and has failed conservative treatment, surgery is usually the best choice.
What is involved if I need surgery for the rotator cuff injury?
The type of surgery will depend on the extent of the problem. Typically, an arthroscopic shoulder surgery will be performed to evaluate the area above the rotator cuff and the shoulder joint itself.
For cases involving tendonosis, partial rotator cuff tears or impingement, the entire procedure can be done arthroscopically through a few small incisions. The surgeon can shave the spur (this is what is known as acromioplasty) so it will not rub on the rotator cuff. Also, any frayed edges of the tendon can be trimmed, creating a smoother edge that no longer catches. Certain partial-thickness tears are almost complete or very high-grade; these likely need to be repaired in order to decrease pain and restore function to the shoulder.
Symptomatic full thickness rotator cuff tears should be repaired. Most full thickness tears can be repaired with a shoulder arthroscopic surgery. Generally, the torn area of rotator cuff is re-attached back to the bone using sutures and small anchors.
Rarely, some rotator cuff tears are so big and frayed that they cannot be repaired. In these cases, the surgeon will clean up torn edges so that they are smooth. While not as good as a repair, many times this will give the patient enough pain relief to perform rehabilitation exercises and restore adequate function to the shoulder
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