Rotator Cuff

What is the rotator cuff?

The rotator cuff is the name for the tendons that surround the shoulder joint. The rotator cuff is important in allowing the shoulder to function through a wide range of motions. In part due to the rotator cuff, the shoulder joint can move and turn through a wider range than any other joint in the body. This motion of the shoulder joint allows us to perform an amazing variety of tasks with our arms.

Unfortunately, a rotator cuff tear is not an uncommon problem, and these injuries make many routine activities difficult and painful. The rotator cuff is part of this mechanism that, when healthy functions very well, but when injured can be a difficult and frustrating problem.

The rotator cuff is actually a group of four muscles and their tendons that wraps around the front, back, and top of the shoulder joint. Together the rotator cuff muscles help guide the shoulder through many motions, and also lend stability to the joint. The ends of the rotator cuff muscles form tendons that attach to the arm bone (humerus). It is the tendinous portion of the rotator cuff that is usually involved in a rotator cuff tear.

Who is most susceptible to a rotator cuff tear?

A rotator cuff tear is seen both in the young and old, but they are much more common in the older population. Usually in younger patients, there is either a traumatic injury, or the patient is demanding unusual use of their shoulder, as seen in professional athletes.

As people age, the muscle and tendon tissue of the rotator cuff loses some elasticity, becomes more susceptible to injuries, and is often damaged while performing everyday activities. This is the reason that rotator cuff tears are more commonly seen in older patients.

What are the symptoms of rotator cuff tear?

The most common symptom of a rotator cuff tear is pain. It is often difficult for a patient to localize the pain to a specific area, rather it is described as a generalized discomfort that is exacerbated with specific movements of the shoulder. Depending on the severity of the rotator cuff tear, there may also be a loss of motion.

If the injury is an incomplete, or partial, tear, pain will likely be the most prominent symptom; decreased strength may be demonstrated, but is usually not the patient's primary complaint. However, in a complete rotator cuff tear, the patient will likely be unable to move the shoulder through some normal motions. The diagnosis of a rotator cuff tear is best made by a physical examination where an orthopedic surgeon can isolate and test the function of the specific muscles that form the rotator cuff.

What treatment is needed for a rotator cuff tear?

Rotator cuff tears do not heal well with time. They tend to either enlarge, or, at best, stabilize in size. The good news is the rotator cuff tears do not necessarily need to heal in order for the symptoms to resolve.

The first steps of rotator cuff treatment include:

• Physical Therapy
  Physical therapy is the most important step in the treatment of a rotator cuff injury. Strengthening the rotator cuff muscles is important to maintain normal shoulder function. A few meetings with a physical therapist can help teach you exercises to help alleviate and prevent a recurrence of your shoulder pain.
• Anti-Inflammatory Medications
  Medications are most helpful at controlling the symptoms of a rotator cuff tear. Simple anti-inflammatory medications can be taken regularly for a short period, and then be used when symptoms of a rotator cuff tear flare up.

These steps may help to relieve pain and strengthen the muscles around the joint.

When is rotator cuff surgery needed?

There are several surgical procedures that are possible for rotator cuff treatment. The two most common procedures are:

• Arthroscopic Repair
  An arthroscopic repair is done with small incisions, and the repair is done by the surgeon looking through a small camera to watch his or her repair on a television monitor. This is a more recent development in treatment of rotator cuff tears, and not all types of tears can be treated by this method.
• Mini-Open Repair
  The mini-open method of repairing a rotator cuff involves both the use of an arthroscope, and a short incision to get access to torn tendon. By using the arthroscope, the surgeon can also look into the shoulder joint to clean out any damaged tissue or bone spurs. The incision is about 3-4 cm, and the recovery is somewhat less involved than the open cuff repair.

How long is the recovery from rotator cuff repair surgery?

This will depend on several factors, including your level of strength before the operation and the severity of the rotator cuff tear. Some period of immobilization of the shoulder joint is needed to protect the newly placed sutures from being disrupted. After one to two weeks, physical therapy begins. Initially, the therapy is gentle so as not to affect the rotator cuff repair. After four to six weeks, more active lifting with the arm begins. Several months after the rotator cuff repair, physical therapy will become more intense in an effort to strengthen the rotator cuff muscles. Complete recovery usually requires at least four to six months.

Rotator cuff tear and arthroscopic repair.

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