Rotator Cuff

What is the Rotator cuff?

The rotator cuff is a set of four muscles that motor the shoulder joint. These muscles originate on the shoulder blade(scapula) and turn into fibrous tendons as they approach their insertion on the top of the upper arm (humerus). These four tendons surround the front, top and back of the head of the humerus. When the rotator cuff muscles contract, they pull on the rotator cuff tendons, allowing the shoulder to move through a wide range of motion and direction. A lubricating tissue or bursa lies on the surface of the tendons, allowing the cuff tendons to glide smoothly under the tip of the shoulder (acromion). See Shoulder Anatomy.

How is the Rotator Cuff injured?

The rotator cuff may be injured by trauma such as falling on an outstretched hand, or by repetitive overhead activity such as in throwing and racquet sports. Either mechanism of injury leads to swelling of the rotator cuff and the overlying bursa. Either injury may result in a complete tear of the rotator cuff.

What is an Impingement Syndrome?

When the rotator cuff tendons and the bursa become swollen and inflamed it produces an impingement syndrome. The thickened tissue becomes pinched between the overlying acromion and the head of the humerus. There is dull aching pain in the shoulder, and frequently more sharp pains with certain motions. The pain is frequently worse at night. Overhead activities such as throwing, serving, spiking, weight lifting, or even reaching into the back seat, or putting on a jacket may be painful. There may be some clicking in the shoulder from thickening of the inflamed bursa.

What is the difference between tendinitis, bursitis, and an Impingement Syndrome?

None.

What are my treatment options?

Most cases of impingement will respond to non-operative care. This begins with activity modification, and avoidance of overhead activities and specifically those motions that aggravate your pain. Your physician may prescribe an anti-inflammatory medication(NSAID). Physical therapy is the cornerstone of treatment and may include modalities such as heat, ice, ultrasound, etc. as well as stretching and strengthening exercises. Often impingements from overuse have an imbalance between internal and external rotation power as well as joint contractures. Once you have made some initial progress, your therapist should instruct you on a home exercise program. If no progress is being made with PT, you should discuss this with your therapist and physician, as you may be a candidate for an injection of cortisone to help alleviate your discomfort. Remember, not all cases are similar, and some won't get better without more invasive treatments.

How do you know if the cuff is torn?

Usually your orthopaedic specialist will be able to tell about the integrity of the cuff by a detailed physical exam. If there are any questions he may request an MRI or an arthrogram to help prove if the cuff is torn. If conservative care has been exhausted, he may wish to proceed directly to arthroscopic evaluation and subacromial decompression, being prepared to perform an open rotator cuff repair if indicated.

Can my problem be cured with the Arthroscope?

The answer depends upon your surgeon, and whether or not your rotator cuff has been torn. If your rotator cuff is intact but just getting pinched with the impingement, a subacromial decompression offers excellent relief in around 85% of the patients. This can be performed either open or with the arthroscope. The early recovery is certainly easier if the procedure is done arthroscopically. If the rotator cuff is torn, you will most generally require an open procedure to repair the defect. The recovery is much longer and more involved once the cuff has been torn.

How can you prevent these problems?

There are several things you can do to prevent shoulder problems of the overuse variety. Your shoulder will respond to increasing demands if you progress slowly. You wouldn't think of beginning a running program by going out on the first day and running a marathon, yet many people begin softball season by "winging one in a rope from deep right field" only to spend the next 4 months on injured reserve. A preseason throwing program, or a rotator cuff and scapular stabilizing program in the weight room can help. If you want more information, ask your physician or therapist.