The rotator cuff is a group of muscles and tendons that surround the shoulder joint, holding the head of the humerus firmly in the shallow scapula. Injury to the rotator cuff can cause a deep shoulder pain, which is often aggravated by using the arm away from the body.
Rotator cuff injuries are common and increase with age. They can also occur earlier in professionals who perform repetitive movements, such as painters and carpenters. Many patients with rotator cuff syndrome can manage their symptoms with physical therapy that improves the flexibility and muscle strength of the muscles surrounding the shoulder joint.
The pain associated with rotator cuff tear can be described as a deep shoulder pain that worsens at night and keeps the patient from sleeping. The patient has difficulty moving the arm.
Rotator cuff tears can result from either a major shoulder injury or progressive degeneration or wear and tear of the tendon. Repetitive activity or lifting heavy objects for an extended period of time can irritate or damage the tendon.
Predisposing factors for rotator cuff tears include increased age, heavy work and heredity. Rotator cuff tears are more common in people over the age of 60. Occupations such as carpentry or painting that require repetitive arm movements, often overhead, can damage the rotator cuff over time.
Without treatment, rotator cuff tears can lead to permanent loss of motion or weakness and progressive degeneration of the shoulder joint. Although resting your shoulder is essential for recovery, prolonged immobilization for long periods of time can cause the connective tissue surrounding the joint to thicken and shrink (frozen shoulder).
The diagnosis of rotator cuff tear is based on clinical examination and imaging. X-ray is used to rule out other conditions such as arthritis. Ultrasound allows dynamic examination of muscles and tendons and a quick comparison of the two shoulders. Magnetic resonance imaging (MRI) shows in detail the entire anatomy of the shoulder and is the test of choice for the diagnosis of rotator cuff syndrome.
Conservative treatment including rest, ice and physiotherapy is sometimes all that is needed to repair the rotator cuff injury. If the injury is severe, surgery may be needed. Injecting steroids into the shoulder joint, especially if the pain interferes with sleep and daily activities, is a temporarily useful solution that should be used with caution, as it may contribute to weakening the tendon and reduce the success of surgery.
Physiotherapy, which usually involves exercises tailored to the specific location of the rotator cuff injury, can help restore flexibility and strength to the shoulder. Physical therapy is also an important part of the rehabilitation process after rotator cuff surgery.
There are many different types of surgery for rotator cuff tears. In arthroscopic rotator cuff suturing, a tiny camera and instruments are inserted through small incisions to reattach the tendon to the bone. If the torn tendon is too damaged to reattach to the humerus bone, a major thoracic or dorsiflexor tendon transfer can be performed. Massive rotator cuff tears combined with arthritis may require a reverse shoulder arthroplasty.