The rotator cuff is a group of 4 muscles and tendons around the shoulder joint. The shoulder joint, like the hip joint, is a ball-and-socket joint. But unlike the hip joint, the ball is not constrained by the shape of the socket. The result is that the shoulder joint is capable of a greater degree and freedom of motion. The rotator cuff acts as a dynamic stabilizer of the shoulder joint, keeping the ball relatively centered in the socket as the shoulder “rotates.”
The 4 rotator cuff muscles are:
- Teres Minor
The rotator cuff is subject to stress and injury from a variety of sources, ranging from shoulder dislocation to degeneration that occurs over time from use.
Symptoms and Diagnosis of Rotator Cuff Problems
There are many different ways that the rotator cuff can cause problems. These problems may also involve other associated structures, like the biceps tendon. Neck disorders, such as herniated discs, may also cause symptoms of shoulder pain. Symptoms that patients experience related to rotator cuff problems include pain, stiffness, weakness, and clicking or popping when moving the shoulder. Rotator cuff problems may or may not be caused by an injury. In some cases there is pain and inflammation, but no structural damage. In other cases, there may be structural damage to the rotator cuff. Making an accurate diagnosis requires obtaining an accurate history, performing a physical examination, and usually obtaining some imaging studies. Plain X-rays are very useful initially. Advanced imaging, such as ultrasound or MRI, may also be recommended. Once an accurate diagnosis is made, an individualized treatment plan can be constructed.
The supraspinatus tendon of the rotator cuff lies at the top of the shoulder joint, directly below a projection of the shoulder blade, or scapula, called the acromion. When the arm is elevated overhead, the space between the acromion and the ball decreases, thereby putting more pressure on the supraspinatus tendon and the bursa that overlies it. This can frequently cause inflammation that is painful. This problem is called “Impingement Syndrome,” and is one of the most common causes of shoulder pain. Pain caused by inflammation of the rotator cuff is generally treated with therapeutic exercise, which may be done at home and/or under the direction of a physical therapist, and some form of anti-inflammatory medication. Cortisone injection may be required to alleviate pain, and in some cases, surgery may ultimately be necessary.
Rotator Cuff Tears
In addition to causing pain from inflammation, the rotator cuff may also be damaged, or torn. Small, partial thickness tears of the rotator cuff are generally treated in a similar way to inflammation. A full-thickness tear, in which the tendon is detached completely from the bone, can range in size from small to massive, and is more likely to require surgery to repair. Rotator cuff repair surgery requires that the tendon be reattached to the bone. It can be performed with traditional open surgery, or with minimally invasive arthroscopic surgery. Recovery time varies, but usually requires at least 3 months, and physical therapy.
Full Thickness Rotator Cuff Tears
Full thickness rotator cuff tears increase in size over time, and patients do not always have symptoms as this occurs. When a rotator cuff tears gets larger, the mechanics of how the shoulder joint moves changes, putting more stress on the cartilage surfaces in the joint. This may eventually cause the development of arthritis in the joint, which can itself be painful and disabling. If a patient has a large chronic rotator cuff tear that has caused arthritis in the joint, several treatment options exist. Physical therapy may help restore range of motion and strength. Medications can alleviate pain when needed. There are several types of injections that can be performed, including cortisone, for relief of symptoms. Hyaluronic acid, or “gel” injections, can also be used for symptomatic relief. These are more commonly used for the treatment of osteoarthritis of the knee. Other injections, such as platelet-rich-plasma (“PRP”) and stem cell injections are currently considered experimental for treatment of rotator cuff disorders and arthritis. The last resort for treatment of this problem is a type of shoulder replacement called a reverse total shoulder replacement.
At Northeast Orthopedics and Sports Medicine, our physicians have the knowledge and experience to diagnose and treat the full spectrum of rotator cuff disorders, using the most advanced and minimally invasive techniques, including an array of non-surgical treatments. If you think you have a rotator cuff problem, schedule a consultation with one of our talented physicians for an evaluation and treatment plan today.