The rotator cuff is a group of muscles and tendons that surround the shoulder joint, keeping the head of your upper arm bone firmly within the shallow socket of the shoulder. Most rotator cuff injuries cause a dull ache in the shoulder, which often worsens with use of the arm away from the body.
A common cause of pain and weakness in the shoulder, rotator cuff injuries can occur as the result of over use or trauma.
Over use injuries are more common in middle aged patients and usually occur in the dominant arm. An individual who is continually performing the same motion (usually overhead) over the years can develop a rotator cuff injury due to the degeneration of a rotator cuff tendon. The repetitive swinging of a golf club, tennis racket or a hammer are all examples of activities that can potentially lead to a rotator cuff injury. It’s not unusual for a person who has injured their rotator cuff as the result of overuse to try to manage their symptoms on their own before seeing a doctor for treatment because the discomfort experienced is more of a dull ache than a sharp pain.
A patient who has injured their rotator cuff as the result of trauma will have symptoms (pain, weakness, discomfort) that are much more intense than a person who has injured their cuff due to overuse. An injury that was caused by a collision or a fall that breaks the clavicle or dislocated the shoulder can cause more than one rotator cuff tendon to be torn.
A partially or full torn rotator cuff tendon can cause:
Pain – pain can be constant or only experienced during certain motions. A dull pain might also be felt when a person is laying down or after an activity.
Weakness – weakness is most commonly experienced during an activity where the arm is in an overhead position but may be experienced in various position.
Limited Motion – limited motion in the shoulder joint may be experienced while trying to perform basic task, like brushing your teeth or hair.
Popping Sound – a clicking or popping sound in the shoulder
An orthopedic shoulder doctor will order X-rays and perform a physical examination. An X-ray is used to check for a bone spur. An ultra sound or MRI may also be ordered so a doctor can fully evaluate the locations and extent of soft tissue damage in the shoulder.
An injured rotator cuff can get worse over time. A patient’s shoulder could continue to weaken and the injury could lead to a progressive shoulder joint degeneration. A torn rotator cuff tendon could also continue to tear over time. Early treatment for a rotator cuff or shoulder joint disorder is very important and can prevent your disorder from getting worse over time.
Most patients who have not severely injured the shoulder joint or rotator cuff will able to manage their pain and improve shoulder function without rotator cuff surgery. Common conservative treatments for a rotator cuff injury include:
Cortisone Injections – may be used by patient who are not able to reduce their pain using the aforementioned conservative treatments. An orthopedic doctor may discuss the use of cortisone injections if it is determined it would benefit the patient.
Some patients may be a candidate for PRP Therapy or Bone Marrow Aspirate Concentrate (BMAC) to treat their rotator cuff injury. These regenerative treatments may be an option to help a minor tendon injury heal properly. Regenerative treatments utilize cells from the patients body, so the risk is minimal. Whether or not you are a candidate will be determined by your medical history and the extent of your injury. For example, if you have a slightly torn rotator cuff and have also developed a bone spur, the bone spur will need to removed surgically.
Patients who do not benefit from conservative treatment or have suffered a large tear in a rotator cuff tendon may need rotator cuff surgery to properly repair the torn rotator cuff and restore function to the shoulder joint.
Surgery to repair torn rotator cuff muscles and tendons may be done as an open procedure or a minimally invasive procedure (arthroscopy). An orthopedic shoulder surgeon will determine the best approach based on the severity of the injury and other factors.
Arthroscopic Surgery is the most commonly used procedure to repair an injured rotator cuff. Small incisions (approximately 1 cm each) are made to allow a surgeon to insert a camera and surgical tools and access the shoulder joint. Arthroscopic surgery allows for a faster recovery and a patient will have less post-operative pain than they would if they had an open procedure. This procedure is normally done on an outpatient basis.
Open Surgery may be used if a patient’s injury is considered to be complicated or severe. This approach allows greater access to the shoulder joint. It may also be used if additional reconstruction or repairs to the shoulder joint are indicated. While it will take a patient longer to recovery from an open procedure. an open approach to surgery provides good outcomes. In some situations, a surgeon may determine a mini-open surgical approach is best, which starts out as an arthroscopic procedure and can potentially end as an open procedure if the surgeon determines more surgery is needed.
During a rotator cuff repair, either procedure can include the removal of bones spurs and inflammatory debris. If a tendon is partially torn, a surgeon will smooth the frayed edges of a damaged tendon (debridement). If the tear is more severe or complete, the tendon will need to be repaired and reattached to it’s original location using stitches or suture anchors.
Our team of orthopedic surgeons, doctors and clinical staff work together to help patients who are experiencing shoulder pain, weakness or a loss of functionality. The Center For Musculoskeletal Disorders has four convenient locations in the New York metro area.
If you are experiencing shoulder joint pain or mobility issues, schedule an appointment with one of our highly experienced orthopedic shoulder doctors to have your condition accurately diagnosed and evaluated. Our physicians will discuss your best treatment options based on your medical history and condition.