What is the rotator cuff?
The rotator cuff is a group of four muscles that surround the ball of the shoulder (humeral head) and originate at the shoulder blade (scapula). The muscles are attached to the bone with tendons. The rotator cuff helps hold the head of the humerus down in the shoulder socket during shoulder motions such as reaching to the side or overhead. It also helps maintain stability of the shoulder joint.
What causes a rotator cuff tear?
The rotator cuff may tear as a result of a direct blow or injury to the shoulder, strain from sudden increase in activity or intensity of use, bone spur off the acromium (roof of the shoulder joint) or aging and degeneration of the rotator cuff tendons.
What are the symptoms of a rotator cuff tear?
Symptoms may include pain that increases with function of the shoulder, aching of the shoulder when it is not in use, night pain, weakness and a limited range of motion.
Exams and Tests?
A physical examination may reveal tenderness over the shoulder. Pain may occur when the shoulder is raised overhead. There is usually weakness of the shoulder when it is placed in certain positions.
X-rays of the shoulder may show a bone spur or change in the position of the shoulder.
Your doctor may order other tests:
An ultrasound test uses sound waves to create an image of the shoulder joint. It can show a tear in the rotator cuff.
MRI of the shoulder may show swelling or a tear in the rotator cuff.
With a joint x-ray (arthrogram), the doctor injects contrast material (dye) into the shoulder joint. Then an x-ray, CT scan, or MRI scan is used to take a picture of it. Contrast is usually used when your doctor suspects a small rotator cuff tear.
What treatment is recommended?
For a partial rotator cuff tear pain-free strengthening exercises are recommended. Cortisone injections can help promote healing in more severe injuries. Partial rotator cuff tears that fail to heal spontaneously may require arthroscopic surgery to remove dead tissue from the tendons and promote healing.
Surgery is recommended for a complete rotator cuff tear. This procedure is most successful during the first few months after the injury, as when the muscle is completely torn the muscle retracts back.
Over time, the retracted muscle tends to scar in place and becomes less pliable making it more difficult to surgically pull back into place and reattach to the humeral head. Studies have shown that over extended periods of time unrepaired torn rotator cuff muscle turns into fatty tissue. The reason for this is unknown.
How is the rotator cuff repaired?
Surgery is done by Arthroscopy.The muscle is pulled back into place with stitches and anchored into the bone using bioabsorbable (absorbed by the body) anchors.
What is the recovery time after surgery?
For the first three to six weeks after surgery, you will need to wear a sling. Usually, after the first four weeks, you are encouraged to start with a pain-free motion of the shoulder joint, and after a few more weeks you can begin doing strengthening exercises.
Physical therapy is usually helpful. You can begin soon after the initial healing has occurred.
Following successful rehabilitation, you can usually participate in unrestricted activities three-six months after complete rotator cuff surgery.