What is a rotator cuff and how can it be injured?
The rotator cuff is actually a combination of muscles and tendons at the top of the upper arm that helps stabilize the shoulder joint and move the arm (both lift and rotation). The “cuff” of muscles attaches to the scapula (shoulder blade) with a tendon connected to the front and side of the humerus bone (upper arm). This network of muscles and tendons gives the shoulder more mobility than any other joint in the body.
Although injury to the rotator cuff can be the result of trauma, such as a dislocation or fracture, tears in any component of the rotator cuff are most often caused by overuse, called wear-and-tear injuries. Any sport or activity that requires repetitive arm movement, like tennis, weight lifting or painting, can lead to a rotator cuff injury. Those who develop tears through overuse may also have experienced several months of pain associated with inflammation, either bursitis, which is inflammation of the joint bursa (fluid), or tendonitis, which is inflammation of one or more tendons.
The symptoms of a rotator cuff tear depend on the cause. Tears caused by trauma may create an immediate and sharp pain in the shoulder and weakness in the arm. Tears caused by overuse may create pain that begins as a minor twinge when lifting the arm. With overuse injuries, pain may develop into chronic distress in the shoulder that radiates and limits your arm and shoulder movements. Pain may even interrupt your sleep.
In order to diagnose you properly, your doctor will consider your symptoms and examine your shoulder and neck to ensure that your pain isn’t caused by a pinched nerve, arthritis, or another condition. You will be asked to perform a few simple movements so that your doctor can measure your range of motion. Your doctor may also require you to have X-rays — to look for contributing bone issues, including spurs, an MRI (magnetic resonance imaging) — to look more closely at the soft tissue (muscles and tendons) of the joint, or an ultrasound.
Your doctor may recommend different treatment options depending on your particular symptoms and the severity of your condition.
Your doctor will likely recommend that you avoid engaging in any activity that causes symptoms or makes your symptoms feel worse. That may mean the temporary use of a sling.
Manage the pain.
Your doctor may prescribe or recommend the use of anti-inflammatory medications (like aspirin or ibuprofen) and ice packs applied to the shoulder to reduce inflammation and pain. Often a local injection of cortisone or lidocaine, or both, helps to further reduce inflammation.
Get the right moves.
Your doctor may recommend several specific strengthening exercises for you to perform on your own throughout the day. You may even be given a prescription for a course of physical therapy. During physical therapy sessions, a trained therapist may apply heat wraps, use painless electro-stimulation, provide massage and/or teach you special exercises to help reduce your pain, increase your motion and improve your strength.
Understand your surgical options.
If you are still experiencing pain after all other conservative measures have been taken, or if your tear is the result of a traumatic injury, your doctor may suggest surgery to repair the tear, help relieve your pain and help restore your mobility. Surgical procedures to repair a rotator cuff tear range from debriding (a procedure in which a partial tear is smoothed) to stitching the torn tendon and, if necessary, re-attaching it to the humerus bone with small anchors. Your doctor will help you to determine the procedure most appropriate for you and for the extent of your injury.
Today’s techniques, matched with newer instruments, may allow your doctor to repair your rotator cuff tear on an outpatient basis with mini-open surgery (requiring only a two- to three-inch incision) or arthroscopic surgery (using a fiber optic scope, requiring even smaller incisions). To secure your repair, your doctor will use anchor options that are designed to meet the needs of your injury, your anatomy and your doctor’s preference, including both titanium and “bioabsorbable” anchors. Bioabsorbables, like Stryker’s BioZip Anchor, are designed to allow the body to use the anchor as a scaffold to build its own permanent repair.
Be sure to talk with your doctor about the best treatment option for you.
Commit to feeling better.
Whether your doctor performs mini-open surgery, or even less-invasive arthroscopic surgery, you will likely be able to go home the same day. You may have to keep your arm in a sling for a period of time while you heal. Although full recovery from rotator cuff injury and repair may take several months, during that time you will be engaged in specific exercises, perhaps a course of rehabilitative physical therapy, to help regain your full range of motion without pain. Complete rehabilitation often depends on your commitment to following your doctor’s recovery recommendations. Your doctor can also help you determine how soon after surgery you can safely begin participating in activities that involve the rotator cuff.
If you suspect that you have signs or symptoms of a rotator cuff injury, please see your doctor for further evaluation and discussion of treatment options.