ROTATOR CUFF INJURY
The rotator cuff is a combination of four muscles (supraspinatus, infraspinatus, teres minor and subscapularis) which originate on the scapula (shoulder blade) and attach to the humeral head (upper arm). The purpose of the rotator cuff is to stabilize the shoulder joint and to position the arm in space.
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Injuries to the rotator cuff can lead to shoulder pain and limitation in shoulder motion. The rotator cuff can be injured after a traumatic event such as a fall on an outstretched arm or an attempt to lift a heavy object. A rotator cuff injury may also occur as a result of “wear and tear” over time without a specific traumatic event.
The spectrum of injury to the rotator cuff ranges from inflammation or tendonitis of the rotator cuff to a partial thickness tear to a full-thickness tear of the rotator cuff. Even in the face of a full-thickness rotator cuff tear, these injuries can potentially be managed effectively without surgery. Anti-inflammatory medications, cortisone injections and physical therapy to strengthen the muscles around the shoulder can be very effective in treating rotator cuff tendonitis, partial thickness rotator cuff tears and some small full-thickness rotator cuff tears. Improvement in symptoms is not overnight, however, and takes a concerted effort from everyone involved (patient, physical therapist, physician). If attempts to conservatively treat an injury to the rotator cuff fail to alleviate symptoms, surgical intervention should be considered. Surgery may involve simply “cleaning out” inflamed tissue around the rotator cuff, or it may involve repairing a torn rotator cuff tendon. The complexity of the surgical procedure depends on the nature of the injury.
[Learn more about rotator cuff repair from eOrthopod]
Sometimes patients may have a combination of shoulder arthritis and a large or irreparable rotator cuff tear. This is known as rotator cuff tear arthropathy. This is a very difficult condition to treat, and multiple treatment options exist, including physical therapy, arthroscopic debridement (“clean-up” procedure), partial rotator cuff repairs, partial shoulder replacement and tendon transfers, depending on the patient’s symptoms and physical examination. Another treatment option is a reverse total shoulder arthroplasty / replacement. This is a unique shoulder replacement that “reverses” the normal anatomy of the shoulder. A “headball” component gets placed where the “socket” is, and a “socket” gets placed where the “headball” is, essentially reversing the parts of the shoulder joint. The reverse total shoulder arthroplasty / replacement can provide significant pain relief and improvement in shoulder movement, particularly raising the arm straight ahead (forward elevation).