Rotator Cuff Injuries
The rotator cuff is the group of four tendons
(supraspinatus, infraspinatus, teres minor, and subscapularis) that
helps rotate the shoulder and aid in overhead reaching. It also acts to
depress the top of the humerus, opening the space between the humerus
and the bone above it, known as the acromion.
What is the difference between rotator cuff tendonitis and a rotator cuff tear?
Rotator cuff tendonitis (also known as “bursitis” or
“impingement”) is an inflammation of the rotator cuff tendon. As a
result of the weakness and inflammation in the rotator cuff, the
humerus rides up against the acromion above it, leading to painful scar
tissue, bursitis, and bone spurs.
A rotator cuff tear is a condition in which a part of the
rotator cuff, usually the supraspinatus, is torn from its attachment to
the humerus. Rotator cuff tears can be partial thickness, where some
fibers have torn and some are still intact, or full thickness, where a
portion of the rotator cuff has completely torn off of the bone.
What causes rotator cuff problems?
Rotator cuff injuries may be caused by a specific incident
such as a fall on the arm, or may come on gradually with no inciting
event. Symptoms include weakness, pain with overhead motion, pain at
night, and popping in the shoulder.
How is it diagnosed?
History and physical exam is important in differentiating
rotator cuff problems from other shoulder problems. The rotator cuff
cannot be seen on xray. MRI is useful to visualize the rotator cuff and
other structures in the shoulder.
What are the treatment options?
Conservative treatments such as physical therapy,
anti-inflammatory medications, and injections may relieve the symptoms.
When nonoperative treatments do not help, surgery may be necessary.
Innovative, new surgical techniques allow rotator cuff surgery to be
performed arthroscopically, avoiding the large, painful incisions of
open surgery. Arthroscopic rotator cuff repair is outpatient surgery
performed through very small incisions. Bone spurs and bursitis above
the rotator cuff are arthroscopically removed. If the rotator cuff is
torn, the tendon is repaired back to the bone using arthroscopically
placed sutures. Postoperative rehabilitation focuses on regaining
shoulder motion and strength. A sling is usually worn for 4-6 weeks
postoperatively. Full recovery can be expected after 3-4 months.
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