Rotator cuff injuries are one of the most common shoulder injuries seen in my practice. They typically occur in patients over the age of 40.
The most common complaints are:
- Pain at night with inability to lie on the affected shoulder
- Weakness lifting overhead
- Pain with lifting especially at the side
The rotator cuff is made up of four muscles in the shoulder. The muscles go from the shoulder blade (scapula) and attach onto the humerus. The shoulder is a unique joint in that it is a ball and socket and can move in a 360 degree arc. Between the roof (acromion) and the rotator cuff is the bursa. It acts like a ball bearing by lubricating the rotator cuff to move freely. Sometimes the bursa will get inflamed and patients can have a sudden onset of pain which can sometimes present like a rotator cuff injury.
Types of Injuries
There are two main types of rotator cuff injuries:
- Partial Tears: This type of tear involves a portion of the rotator cuff and does not completely tear the tendon.
- Complete Tears: This is more severe and completely cuts the rotator into separate pieces. It can occur near the attachment of the tendon into bone or within the tendon substance.
Most rotator cuff tears are from repetitive type of trauma. The tendon may be rubbing on a bone spur and over time it begins to fray and eventually tears. It also occurs in activities involving overhead motion: tennis, weightlifting, and baseball.
When shoulder pain persists and does not respond to rest and/or anti-inflammatory medication then it is recommended that you see your doctor. Treatment is usually conservative and most patients do not need surgery.
- Conservative Treatment: This would include rest, modifying activities that produce shoulder pain, anti-inflammatory medication, physical therapy and possibly a cortisone injection.
- Surgery: A patient would need surgery if the symptoms persist and the patient has failed conservative treatment. For those patients with complete rotator cuff tears in their dominant shoulder, then surgery is more then likely to be necessary. This is especially so in workers who do any heavy lifting. The surgery involves reattaching the rotator cuff tendon to the bone or suturing the tendon back to itself. This depends on the location of the tear.