The rotator cuff is a group of tendons and muscles that surround the shoulder joint, and form a covering around the head of the upper arm (humerus). It connects the shoulder blade (scapula) to the upper arm (humerus). The rotator cuff has the important job of keeping the shoulder in the shoulder socket, providing stability to the shoulder, and enabling the shoulder to rotate. It helps us lift and rotate our arms. Between the rotator cuff and the bone on top of the shoulder, there is a lubricating sac called a bursa. This sac helps the rotator cuff glide freely when we move our arms. The bursa can become inflamed and painful when the rotator cuff tendons are injured or damaged.
There are different types of tears: complete and partial. In a complete tear, the tendon has split into two pieces. A tendon may also tear off at the spot where it attaches to the head of the upper arm. A partial tear means the tendon is damaged, but not completely severed.
The two main causes of rotator cuff tears are injury and degeneration.
- Injury: A tear caused by an injury can happen if someone falls, lifts a heavy object in a non-ergonomically correct manner. It can also happen if a person has another shoulder injury, such as a broken collarbone or dislocated shoulder.
- Degeneration: Several factors can contribute to degenerative rotator cuff tears:
– Rotator cuff tendons can begin to fray with overuse/repeated stress (lifting of heavy objects, repetitive movements in sports such as baseball, swimming, rowing, tennis; manual labor).
– Lack of blood supply – As we age, blood supply decreases in the rotator cuff tendons. The body’s natural ability to heal an injury is compromised without food blood supply, which may lead to a tendon tear.
– Bone spurs – Bone overgrowth (or spurs) can happen at any time, but is more common as we age. A spur can develop on the underside of the bone and subsequently rub on the rotator cuff tendons. This condition is called impingement and over time will weaken the tendon, making it more likely to tear.
Once fraying of the tendon starts, damage can progress and a person may experience a complete tear. When one of the tendons in the rotator cuff is torn, the tendon is no longer fully attached to the upper arm.
What can we do about a rotator cuff problem? Unless the situation is dire, at OSC we begin with conservative care. This includes rest, activity modification, Non-Steroidal Anti-Inflammatory medications, physical therapy and strengthening exercises, and possibly a steroid injection. More than half of our patients see improvement in function and less pain.
If the patient is not satisfied with the level of improvement, we will discuss surgical options after an MRI reveals the full extent of the shoulder damage. Advancements in surgical techniques for rotator cuff repair include less invasive procedures( all procedures except shoulder replacement are done arthroscopically). All surgical repairs can be done on an outpatient basis. The goal is to give the patient pain relief, strength improvement and overall satisfaction. The surgeon makes very small incisions and inserts a small camera in to the shoulder joint. The camera displays the image on a television screen, and the surgeon uses these to help him/her guide the miniature surgical instruments.
Pain is always part of the recovery process after surgery. The surgeon and his/her team will work with the patient to reduce and manage pain so the patient can focus on recovery. Rehabilitation plays a crucial role in returning the patient to activities. Depending on how extensive the surgery was, the surgeon may or may not recommend formal physical therapy sessions. Patients will receive specific instructions on passive exercises in the beginning, and progress to active exercises after several weeks. A complete recovery can take months. The patient’s commitment to rehabilitation is key to a successful outcome.