Rotator Cuff Injuries

The Rotator Cuff – not rotary cuff, as some people call it – is a broad tendon that covers the humeral head –or ball of the shoulder joint. The shoulder is a ball and socket joint. Both are very shallow and the joint would be unstable were it not for multiple muscles and ligaments which hold the ball and socket together. The fact that the joint is shallow allows for better and circular motion of the shoulder.

The rotator cuff is actually a broad tendon which, to me, looks like a bathing cap-covering the ball of the shoulder like a cap covers one’s head. Four muscles converge into the cuff –the subscapularis, the supraspinatus, the infraspinatus, and the teres minor. The tendon attachments of the middle two muscles (the supraspinatus and the infraspinatus) are more commonly torn.

These muscles allow internal and external rotation of the shoulder and assist the larger muscle that covers the shoulder-the deltoid – with abduction(raising the arm sideways and upwards). The deltoid abducts the arm, but cannot do so without the assistance of the rotator cuff muscles. This is why patients with a strong, normal deltoid but with a large rotator cuff tear frequently cannot lift their arm.

I mainly see three rotator cuff conditions:

1. TENDONITIS or TENDONOSIS.

Tendonitis means that the cuff tendon is inflamed and clinically there is tenderness and pain on movement. Overhead elevation produces pain –a positive Impingement Sign. Under arthroscopic visualization, the cuff looks scarred and irregular. Calcium deposits may occur.

Depending on the severity of this condition, I try to initially treat this problem with rest, therapy, and anti-inflammatory medications. Frequently, I give a cortisone injection ,which commonly works.

If these conservative measures, fail, the last resort could be arthroscopic surgery to smooth and clean out the scar tissue. This is usually successful and the recovery time is short –most of my patients regain full motion within a week or two.

2. PARTIAL ROTATOR CUFF TEAR

This is commonly associated with tendonitis ( above) and the treatment is the same. I first recommend conservative treatment. If surgery is later performed, I usually smooth and clean out the scar tissue adjacent to the partial tear and it probably heals without surgical repair or opening up the shoulder. 

3. COMPLETE ROTATOR CUFF TEAR

This is a full thickness tear – a complete tear: the size of the tear is commonly the size of a dime but frequently larger. Usually, although, not always, the patient cannot raise his or her arm, or if they can, they do so with pain. The tear could be caused by chronic use and wear in an older person. In younger people or in workers who do heavy labor, it can be caused by an acute wrenching injury. Falling directly on the shoulder can tear the rotator cuff. Throwing hard can do it. Or some injury that jams the arm — thus transmitting force towards the shoulder– can tear it.

These are serious injuries. The treatment is frequently surgical –commonly with a skin incision. The tear is stitched together. Sometimes, it can be repaired arthroscopically, but usually a small mini incision is necessary. Post operatively, a sling to rest the arm and to allow the repair to heal is needed for 3-4 weeks. And then, physical therapy to rehab the shoulder –for 2-3 months – or longer. No picnic!

But, the results are frequently good, although there are no guarantees. Much of the success of this surgery depends on the patient. Patients must adhere to their doctor’s orders, lest they re-tear the repair in the vital post-operative period. And, if they do not follow-through with their rehab program, they may develop stiffness, a frozen shoulder, or weakness. And in older patients with poor circulation, the repair may not heal ;  also,  in patients who smoke or have diabetes.

Some people with large tears, paradoxically, have surprisingly decent shoulder motion. If these patients have relatively little pain, they theoretically could avoid surgery if they can live with this condition. But, most people with rotator cuff tears have trouble and require surgery.

Is there treatment besides surgery ?  Probably not.  Physical therapy could be offered for the patient in the paragraph above, but therapy will not heal the tear. Large tears most probably will not heal, so surgery is usually indicated for these.

 

Please note: these articles are for general information. They are not intended to serve as medical advice or treatment for a specific problem. Diagnosis and treatment of a problem can only be accomplished in person by a qualified physician.

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