Rotator Cuff Injuries

Have you ever been told that you have shoulder bursitis, tendinitis, impingement or a rotator cuff tear? All of these terms have something in common. They all represent inflammation and various stages of damage to the tissue around the rotator cuff.

The rotator cuff is a group of four shoulder muscles responsible for mobility and strength of the shoulder joint. The rotator cuff can be injured after a major fall or trauma. It is commonly injured with repetitive overhead activity using the arm. Most people with a rotator cuff injury complain of pain and weakness of the shoulder. Stiffness is also a common symptom. Almost everyone says that they have trouble sleeping on that shoulder.

When I see patients in my office, I look for tenderness around the shoulder, pain when the arm is brought out to the side, and a few other maneuvers that confirm a rotator cuff injury. X-rays can tell me a lot about what is going on. Often times the shape of the shoulder bones can play a part in rotator cuff injuries. A "bone spur" on the top of the shoulder can dig and "pinch" the rotator cuff muscles. This is commonly called shoulder "impingement." A test called an MRI can tell you a lot about the rotator cuff. It is a special scan that can show tissue deep in the shoulder very clearly (something an x-ray can't do). It is very accurate in diagnosing a rotator cuff tear.

Examination of the shoulder, x-rays and MRI can usually confirm the diagnosis of shoulder pain.

Here are a few common causes of shoulder pain.

• Bursitis is inflammation of the bursa sac located just above the rotator cuff.
• Tendinitis is inflammation of the rotator cuff tendon.
• Impingement is caused by bone spurs above the rotator cuff digging into it with reach and overhead activities.
• Rotator cuff tear is a tear of the tendon from it’s attachment on the humerus (upper arm bone).
  
  

The initial treatment of shoulder pain is the same. When stiffness and pain are present, I will encourage the use of anti-inflammatory medications and an exercise program to stretch and strengthen the rotator cuff. When I see a bone spur, I will often recommend a cortisone shot to help with the inflammation. The cortisone is not injected into a muscle, joint or ligament, but is injected into a space between the shoulder bones.
If you have done it all and you still have pain, you might need surgery. After physical therapy, medications, rest, x-rays, MRI and a few cortisone injections, patients with significant bone spurs may need surgery to remove them. If the rotator cuff is torn and the shoulder is not functional after the above treatment, surgery is usually required. The torn rotator cuff does not heal on its own. With time, most tears can increase in size. The results of rotator cuff repair surgery are better with a smaller tear. As a surgeon, I find it easier to fix a smaller tear than a large one. The surgery heals faster and patient satisfaction is much higher when the tear is not large or massive.
If surgery is necessary, most doctors will smooth or flatten the bone spurs, remove inflamed tissue and also repair the rotator cuff tendon if it is torn. I prefer to do these procedures arthroscopically unless the rotator cuff tear and bone spurs are very large. If arthroscopic surgery is done, most patients wear a sling for about a week, and gentle therapy is started. For surgery done through a larger incision, most patients are in a sling a few weeks longer to protect the muscles that were cut and repaired during surgery.
Most surgical patients regain motion and strength. After surgery, patients report that they have less pain with reach, and overhead use of the arm is improved. They say that they are finally able to sleep on the shoulder.