Rotator Cuff Tears
The rotator cuff consists of four muscle-tendon units deep in the shoulder. They are the subscapularis, supraspinatus,
infraspinatus and teres minor tendons. Injuries to the rotator cuff, occasionally known as the rotocuff, occur with repetitive
overuse or trauma. The degenerative affect of aging is also a large factor.
The rotator cuff tendons and surrounding bursa become stressed causing tendonitis and bursitis, which is called impingement.
A tear results when the already weakened tendons are further stressed by activity or impact, such as that which is experienced
in the constant grinding of an "overhead sports athlete," or an individual involved in repetitive overhead activities. Damage
to the Rotator Cuff usually results in chronic pain, weakness, shoulder tenderness, and sleeplessness from night pain.
Most rotator cuff injuries can be approached non-surgically. They may be treated with anti-inflammatory medication, nutritional supplements, and a course of shoulder exercises with a Thera-Band®, which is a latex resistive exercise band designed to designed to strengthen the shoulder by providing both positive and negative force on the muscles, as well as improve range of motion and cooperation of muscle groups. Thera-Band® exercises help strengthen the shoulder in Flexion, Abduction, Internal rotation and External rotation. They also help stretch the shoulder into internal rotation, as well as strengthen the Scapula Rotators – namely the lower trapezious, rhomboids, and serratus anterior, which are key muscles to help the scapula rotate out of the “impingement”zone. Three sets of 12 repetitions of each exercise are necessary each day.
Activity modifications are also necessary. Patients need to keep the arm out in front of them and keep the elbow beneath the shoulder level.
In some cases, pain persists and an injection of cortisone into the shoulder is considered. Generally, this will yield good results
without complications. Cortisone injections may be repeated in six weeks if necessary. No more than two injections in six weeks should
be given, as repetitive cortisone injections will weaken the tendon and could cause rupture. If a good result is achieved, then the injection
may be repeated in six months, if necessary.
For patients with history of severe trauma or profound weakness, these treatments will not be successful. In these patients, imaging
studies such as MRIs, or arthrograms, may be necessary. And consideration of arthroscopic shoulder surgery
is given. Arthroscopic surgery is used to remove the bursa - section the coracoacromial ligament - and smooth the undersurface of the
acromion, which usually has developed a spur. If tears of the rotator cuff tendons are present, they are repaired with suture anchors. Arthritis of the acromioclavicular joint, and other
shoulder pathology may be addressed at the same time.
Out of town patients should plan a two-day stay for this procedure.
