Rotator Cuff Injuries

“Being challenged is inevitable. Being defeated is optional”
— Anonymous

Rotator Cuff Anatomy

rotator cuff.png
Rotator cuff tear.jpg
 

Overview

The rotator cuff is made up four muscles and their corresponding tendons that connect the Humerus (upper arm bone) with the Scapula (shoulder blade). These muscles function to help hold the ball of the humerus firmly to the shoulder socket as well as aid with arm motion.

Rotator cuff injuries are common and increase in incidence with age. They can occur with a single injury such as a fall or with lifting, but more commonly occur as degeneration and repetitive irritation with time.


Typical Rotator Cuff Injuries:

  1. Tendinitis/Bursitis

  2. Impingement

  3. Strain or Tear


Symptoms:

The pain associated with a rotator cuff injury may

  • Be described as a dull ache deep in the shoulder

  • Disturb sleep

  • Make it difficult to comb your hair or reach behind your back or overhead

  • Be accompanied by arm weakness

Treatment:

Rotator cuff injuries are very common problems and can many times be treated without surgical intervention. Common treatments include:

  1. Rest

  2. NSAIDs (anti-inflammatory medications)

  3. Physical Therapy

  4. Injections

    1. Corticosteroids for inflammation relief

    2. Biologic Injections

Rotator Cuff Treatment

Rest

Often activity modification is all that is needed. Avoidance of repetitive overhead activities, as well as reaching or lifting far away from your body may be all that is required. Initial rest allows for inflammation to decrease.

 

Physical Therapy

The shoulder is a complex joint, having more motion than any other joint in the body. It is very common for this motion to get out of rhythm (dyskinesia) which can lead create abnormal stress on the rotator cuff. Physical therapy/Exercise management is often the most effective way to treat rotator cuff pain nonsurgically.

Anti-Inflammatories

NSAIDs or Anti-inflammatory medications can aid with decreasing inflammation and pain in the shoulder. Short-term usage (2-6 weeks) can help the body decrease inflammation to aid with decreasing pain and return of function.

 

Injections

Corticosteroid injections are anti-inflammatory medications that are directed at the site of pain and inflammation. While not a cure in themselves, they can be used to aid with decreasing inflammation allowing earlier return to activity, or to potential push passed plateaus with physical therapy.

Additional injection options include biologic management.

Surgical Intervention

Surgical intervention and recommendations are personalized for each patients problem. Common indications for surgical intervention include a failure to respond adequately to nonsurgical management, fixation of those with acute tears corresponding with a change in function, or in younger patients in an effort to prevent tear progression.

Surgical treatment depends multiple factors including the tear pattern, size of the rotator cuff tear, as well as patient specific factors. Surgical options can include debridement (cleaning margins of tear), arthroscopic or open surgical repair, Superior capsular reconstruction (creation of new rotator cuff), tendon transfers, or reverse shoulder replacement.