The rotator cuff is a group of muscles and tendons that surround the shoulder joint, keeping the head of upper arm bone firmly within the shallow socket of the shoulder.
A rotator cuff injury can cause a dull ache in the shoulder, which often worsens when you try to sleep on the involved side.
Rotator cuff injuries occur most often in people who repeatedly perform overhead motions in their jobs or sports. The risk of rotator cuff injury also increases with age. Many people recover from rotator cuff disease with physical therapy exercises that improve flexibility and strength of the muscles surrounding the shoulder joint.
Sometimes, rotator cuff tears may occur as a result of a single injury. In those circumstances, medical care should be provided as soon as possible. Extensive rotator cuff tears may require surgical repair, transfer of alternative tendons or joint replacement. Tears resulting from major injury can usually be repaired successfully if surgery is not delayed more than several weeks.
Weakened degenerative cuff tissue is more easily torn even by normal activities. Durable repair of these tears may not be possible because of the lack of sufficient quantity and quality of tendon tissue. For these reasons patients should seek prompt evaluation of shoulder weakness by an experienced shoulder surgeon especially if the weakness comes on suddenly or after an injury.
Injuries to the shoulder are common. Athletes and construction workers often have rotator cuff injuries due to repetitive movement and overuse of the shoulder. The rotator cuff may be damaged from a fall or other injury to the shoulder. Damage may also occur slowly over time. In older patients, there may not be an injury or event to cause the tear. The damage may be due to:
Recurrent pain, limited ability to move the arm, and muscle weakness are the most common symptoms.
If medical treatments are not satisfactory, rotator cuff repair surgery may be needed. Medical treatments for rotator cuff injury may include the following:
Rotator cuff surgery may be performed using an arthroscope. An arthroscope is a small, tube-shaped instrument that is inserted into a joint. It consists of a system of lenses, a small video camera, and a light for viewing. The camera is connected to a monitoring system that allows the doctor to view a joint through a very small incision. The arthroscope is often used in conjunction with other tools that are inserted through another incision.
An open repair may be performed if the rotator cuff injury cannot be repaired using arthroscopy. In some cases, a tendon graft and joint replacement may be necessary.
There may be other reasons for your doctor to recommend rotator cuff repair.
As with any surgical procedure, complications can occur. Some possible complications may include:
Before the procedure
During the procedure
Rotator cuff repair may be performed on an outpatient basis or as part of your stay in a hospital. Procedures may vary depending on your condition and your doctor’s practices.
Rotator cuff repair may be performed while you are asleep under general anesthesia, or while you are awake under local or regional anesthesia. If regional anesthesia is used, you will have no feeling from your shoulder down. The type of anesthesia will depend on the specific procedure being performed. Your doctor will discuss this with you in advance.
Generally, rotator cuff repair surgery follows this process:
After the procedure
After surgery you will be taken to the recovery room for observation. Your recovery process will vary depending on the type of anesthesia that is given and the type of surgery that is performed. The circulation and sensation of the arm will be monitored. Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to your hospital room or discharged to your home.
You may be given an immobilizer or sling before you go home.
Once you are home, it is important to keep the surgical area clean and dry. Your doctor will give you specific bathing instructions. The stitches or surgical staples will be removed during a follow-up office visit.
Take a pain reliever for soreness as recommended by your doctor. To help reduce swelling, you may be asked to apply an ice bag to the shoulder several times per day for the first few days. You should keep the sling or immobilizer on as directed by your doctor.
Your doctor will arrange for an exercise program to help you regain muscle strength, flexibility, and function of your shoulder.
Notify your doctor to report any of the following:
You may resume your normal diet unless your doctor advises you differently.
You should not drive until your doctor tells you to. Other activity restrictions may apply. Full recovery from the surgery may take several months.
Surgery to repair a torn rotator cuff is usually successful in relieving pain in the shoulder. The procedure may not always return strength to the shoulder. Rotator cuff repair can require a long recovery period, especially if the tear was large.
When you can return to work or play sports depends on the surgery that was done. Expect several months to resume your regular activities. Some rotator cuff tears may not fully heal. Stiffness, weakness, and chronic pain may still be present.
These poorer results are more likely when the following are present:
Shoulder is made up of three bones: your upper arm bone/humerus, your shoulder blade, and your collarbone/clavicle. The shoulder is a ball-and-socket joint: The ball, or head, of your upper arm bone fits into a shallow socket in your shoulder blade.
Your arm is kept in your shoulder socket by your rotator cuff. The rotator cuff is a network of four muscles that come together as tendons to form a covering around the head of the humerus. The rotator cuff attaches the humerus to the shoulder blade and helps to lift and rotate your arm.
There is a lubricating sac called a bursa between the rotator cuff and the bone on top of your shoulder. The bursa allows the rotator cuff tendons to glide freely when you move your arm. When the rotator cuff tendons are injured or damaged, this bursa can also become inflamed and painful.
A rotator cuff tear may result from an acute injury such as a fall or may be caused by chronic wear and tear with degeneration of the tendon or a combination of both acute and chronic causes. Impingement of the front of the scapula, “the acromion”, on the tendon is believed to be a major cause of cuff tears in individuals older than 40 years.
Several factors contribute to degenerative, or chronic, rotator cuff tears:
When one or more of the rotator cuff tendons is torn, the tendon no longer fully attaches to the head of the humerus. Most tears occur in the supraspinatus muscle and tendon, but other parts of the rotator cuff may also be involved. In many cases, torn tendons begin by fraying. As the damage progresses, the tendon can completely tear, sometimes with lifting a heavy object.
Typically, you will feel pain in the front of your shoulder that radiates down the side of your arm. It may be present with overhead activities such as lifting or reaching. You may feel pain when you try to sleep on the affected side. You may note weakness of your arm and difficulty with routine activities such as combing your hair or reaching behind your back.
If the tear occurs with injury, you may experience acute pain, a snapping sensation, and immediate weakness of the arm. These symptoms can occur more easily after injury in an ageing patient.
The signs and symptoms of a rotator cuff tear depend on the size and extent of the tear and the length of time that it has been present. In most cases, pain is the predominant feature. This occurs because of inflammation around the damaged tendon, as well as mechanical catching of the tendon in its tunnel under the acromion. The pain occurs with use of the arm, particularly elevation to and above shoulder height. Pain also occurs at night, which is particularly disabling because of the interference with sleep. Weakness, associated loss of power and movement may occur, depending on the size of the tear.
Once the rotator cuff tears, it does not heal, and surgery may be necessary to repair the tendon. If extensive tears are not treated, the result is deteriorating shoulder function, the onset of widespread arthritis in the shoulder region, and increasing pain over time. The ability to offer surgery to repair torn tendons depends on many factors and unfortunately not all patients are candidates for successful surgery.
The most common symptoms of a rotator cuff tear include:
Tears that develop slowly due to overuse also cause pain and may cause arm weakness. You may have pain in the shoulder when you lift your arm to the side, or pain that moves down your arm. At first, the pain may be mild and only present when lifting your arm over your head, such as reaching into a cupboard. Over-the-counter medication, such as aspirin or ibuprofen, may initially relieve the pain.
Over time, the pain may become more noticeable at rest, and no longer goes away with medications. You may have pain when you lie on the painful side at night. The pain and weakness in the shoulder may make routine activities such as combing your hair or reaching behind your back more difficult.
There are different types of tears:
A rotator cuff tear can extend or get larger over time. This can occur with repetitive use or a re-injury. It is common for patients with known rotator cuff disease to have acute pain and weakness following a minor injury. This likely represents extension of an existing tear. If you know you have a rotator cuff tear then worsening pain and decreasing strength may mean the tear is getting larger.
Early diagnosis and treatment of a rotator cuff tear may prevent symptoms such as loss of strength and loss of motion from setting in. A consultation with an orthopedic surgeon is recommended, and an Ultrasound/MRI is usually required to confirm the diagnosis. Appropriate surgical or non-surgical treatment can then begin.
The goal of any treatment is to reduce pain and restore function. There are several treatment options for a rotator cuff tear, and the best option is different for each person. In planning your treatment, your doctor will consider your age, activity level, general health, and the type of tear that you have. Surgical treatment is not necessary if pain and loss of function are not significant problems depending on your age and the circumstances of how the tear occurred.
Non-surgical treatment options may include:
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