What is the Rotator Cuff?
The rotator cuff is a group of four muscles and tendons that surround the shoulder. The rotator cuff assists in raising the arm away from the body and overhead. It also maintains proper position of the shoulder joint and provides stability to the shoulder joint. Rotator cuff tears are a common source of shoulder pain for many individuals.
Rotator Cuff Injuries
There is a spectrum of injuries that occur in the rotator cuff ranging from inflammation and tendonitis to a complete tear to the tendon. A rotator cuff tear can happen for a number of reasons. It can happen in older patients without an injury from wear and tear of the rotator cuff tendon. This comes as a result of years of overuse to include frequent reaching overhead or repetitive lifting. Rotator cuff tears can also occur secondary to a fall onto your arm, elbow or shoulder. Lifting something heavy can also cause a tear.
The common symptoms patients experience with a rotator cuff are pain and weakness. Patients will notice the most pain and weakness in their shoulder when reaching overhead. A physician can usually tell if a patient has a rotator cuff tear just by examination. However, sometimes it is not so obvious on physical examination. An MRI provides accurate detail of the rotator cuff tendon and can tell if there is a rotator cuff tendon tear. It can also determine whether there is a partial or full thickness tear and which tendons are torn. X-rays do not show soft tissues so they do not diagnose rotator cuff tears.
There are non-operative and operative treatment options. Partial thickness rotator cuff tears mean that part of the tendon is torn but part of it remains attached. Most partial thickness tears can be treated without surgery. Complete or full-thickness rotator cuff tendon tears can also be treated with or without surgery. Often full-thickness rotator cuff tears that cause pain and weakness are treated with rotator cuff repair. I performed this arthroscopically, which is a surgery using a camera and small incisions. Rotator cuff repair requires physical therapy and extensive rehabilitation following surgery. There are many factors that go into the decision to perform surgery or conservative treatment for a complete rotator cuff tear.
Who is at risk?
Rotator cuff tears are more common in older patients, specifically older than 40 years old. The risk of rotator cuff tears increases as we age. Patients that do repetitive lifting or reaching overhead are at increased risk for rotator cuff tears. Unfortunately, rotator cuff tears are generally a part of the aging process and can occur without significant overuse or injury. The best way to lower your risk of rotator cuff injury or tears is to do rotator cuff and shoulder strengthening exercises 2-3 times per week. There are specific exercises that isolate the rotator cuff muscles and tendons. Generally, normal upper body workouts and strenuous work or labor do not strengthen the rotator cuff.
Editor’s Note: This article was contributed by Dr. Scott King, an orthopaedic surgeon with OSS Health.