What Is the Rotator Cuff?
The shoulder is one of the most mobile joints in the body, but that mobility comes at the price of stability. The rotator cuff is a group of muscles and tendons designed to hold two of the shoulder bones in place while allowing for a large range of motion and powering the shoulder in many directions.
The upper arm bone, called the humerus, fits into a shallow hole in the shoulder blade called the glenoid. Together, these form the glenohumeral joint. The rotator cuff is made of four muscles—the supraspinatus, infraspinatus, teres minor and subscapularis—as well as tendons that attach them to the humerus, and a fluid-filled sac called a bursa that lubricates the joint when the arm is raised or rotated. The rotator cuff supports the glenohumeral joint and holds it in place while providing strength and range of motion in lifting or reaching for objects.
Common Rotator Cuff Injuries
Rotator cuff injuries were responsible for nearly two million doctor visits in 2013, according to the American Academy of Orthopaedic Surgeons. They’re also the most common cause of shoulder pain in people over the age of 30. The two more common forms of rotator cuff injuries are rotator cuff tendinitis—also called tendinopathy or impingement syndrome—and rotator cuff tears.
Rotator cuff tendinitis is an irritation of the tendons of the rotator cuff, which may occur as a result of the tendons rubbing against the bones of the shoulder. Repetitive motion and age-related degeneration are the most likely causes of tendinitis. People whose jobs or sports involve frequently lifting overhead are especially susceptible to rotator cuff tendinitis.
A rotator cuff tear is when one or more of the tendons of the rotator cuff either partially or completely detach from the humerus. Sudden injury more often results in a rotator cuff tear rather than tendinitis.
Pain and weakness of the arm are the most common symptoms of both rotator cuff tears and tendinitis. The pain may begin gradually with tendinitis, but it is usually sudden and severe upon receiving an injury that causes a rotator cuff tear. Stiffness and weakness when trying to raise the arm are also telltale signs of rotator cuff injury. Many people experience pain at night and difficulty sleeping.
The first step in treating a rotator cuff injury is determining the type of injury. A doctor will take a medical history and perform a physical exam, paying special attention to symptoms, lifestyle—including jobs or activities that require repetitive overhead movement of the arm—and any acute injuries that may be responsible for the pain.
If a rotator cuff tear is suspected, an advanced imaging study such as a magnetic resonance imaging (MRI) scan may be ordered. Since a rotator cuff injury is a trauma to soft tissue instead of bone, an X-ray may not be helpful in determining tendon damage but can show bone spurs or other bone changes due to longstanding large rotator cuff tears.
Both conservative and surgical treatments can help heal a rotator cuff injury. Nonsurgical treatment methods include:
- Anti-inflammatory medications
- Corticosteroid injections
- Lifestyle changes such as ceasing the activities that cause pain
- Physical therapy
Surgery is usually recommended for some complete rotator cuff tears, especially in active people who have tried more conservative treatment without success. It can be performed arthroscopically or as an open surgery.
An open surgery involves making a three- to four-inch incision in the shoulder, while arthroscopic surgery is done with or more small incisions, small tools and a flexible camera attached to a video monitor. The aim of both surgeries is to reattach the tendon to the bone.
The surgeon may find other conditions, such as biceps tears or bone spurs, which can be addressed as part of the rotator cuff repair.
Both surgeries are usually performed in a hospital or outpatient surgery center, under general anesthesia, and take one to two hours. Most patients will receive a nerve block that numbs the arm, decreasing pain both during and after the surgery. Patients can often go home the same day, but a full recovery may take three to six months.
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