Rotator Cuff Syndrome

The rotator cuff is comprised of four muscles and their tendons in the shoulder, connecting the upper arm and shoulder blade.  Rotator cuff syndrome refers to any injury, pain, or loss of function related to the muscles and tendons of the rotator cuff group.  The most common causes of shoulder dysfunction are a sports injury where there is low impact repetitive damage to the affected area or a sudden trauma to the shoulder.  There are three sources of injury that cause rotator cuff syndrome.  Tendinitis when the rotator cuff tendons are be irritated or damaged, bursitis when the lubricating sac in the shoulder called the bursa becomes inflamed and swells with more fluid causing pain, and impingement which occurs when the space between the acromion and rotator cuff narrows. The acromion “rubs against” or "impinges" on the tendon and the bursa, causing irritation and pain.

Common symptoms pain in the shoulder during activity or at rest, sudden and sharp pain when lifting or extending the arm, and local swelling. If allowed to progress, pain will increase, and there could be a loss of strength, and a reduction in the shoulder range of motion.  Conservative treatment options begin with rest, ice, and anti-inflammatory medication and can include physical therapy.  If symptoms persist steroid injection may be coupled with aggressive physical therapy for restoring range of motion.  Regenerative medicine options such as stem cell injection therapy may also be considered.  In some instances shoulder arthroscopy or subacromial decompression may be required to restore range of motion and correct shoulder impingement and associated pain.  Our sports medicine specialists are available to evaluate patients with rotator cuff syndrome or other orthopedic concerns.

Rotator Cuff Tears

The rotator cuff consists of muscles and tendons that hold the shoulder in place. The rotator cuff is a group of four muscles that are positioned around the shoulder joint. They help to stabilize the shoulder joint and also help with shoulder joint movement. The rotator cuff allows a person to lift his or her arms and reach up. Injury to Rotator Cuff tissue is commonly referred to as a: rotator cuff tear.  Tears can be partial, incomplete, complete, full thickness, partial thickness, degenerative, articular sided, bursal sided, or intrasubstance.  A frequent cause of pain or instability of the shoulder is a labral tear. A particular kind of labral tear involving the superior labrum is a SLAP (Superior Labrum Anterior to Posterior) tear.  Overuse or acute injury can cause the labrum to tear or detach. 

Common mechanisms of injury include acute injury to the shoulder such as a seatbelt/shoulder harness injury or a fall on an outstretched arm. Also, repetitive forces such as those seen with overhead or throwing athletes, like a pitcher or quarterback, are frequently responsible for SLAP lesions. Rotator cuff tear causes severe pain, weakness of the arm, and crackling sensation on moving shoulder in certain positions. There may be stiffness, swelling, loss of movements, and tenderness in the front of the shoulder.

Many rotator cuff tears respond well to conservative therapy.  Initial treatment includes rest, the use of a sling to immobilize the shoulder, and anti-inflammatory medications.  Additional conservative options include pain medication such as the injection of a steroid such as cortisone and a local anesthetic in the subacromial space of the affected shoulder to help decrease the inflammation and pain.  Often this can be coupled with aggressive physical therapy with good result.  Some patient opt for regenerative options including the introduction of stem cells to the shoulder to encourage healing of the damaged tissue.  Rotator cuff repair may be performed by open surgery or arthroscopic procedure. In arthroscopy procedure space for rotator cuff tendons will be increased and the cuff tear is repaired using suture anchors. These anchor sutures help in attaching the tendons to the shoulder bone.  Surgery should be considered after these other methods of treatments are exhausted without good result. Rotator cuff repair is typically accomplished by arthroscopic procedure. Surgery to repair a torn rotator cuff most often involves re-attaching the tendon to the head of humerus (upper arm bone). A partial tear, however, may need only a trimming or smoothing procedure called a debridement. A complete tear within the thickest part of the tendon is repaired by stitching the two sides back together.  Our orthopedic surgeons use the latest in surgical and non-surgical techniques to care for the full range of athletic, degenerative, and traumatic shoulder disorders.