Definition and Overview
The rotator cuff consists of tendons and muscles that work together to keep the upper arms stable. It also allows shoulder movement. It makes it possible for people to lift their arms overhead, extend their shoulders, and hold their arms straight.
Disorders of the rotator cuff are the most common causes of shoulder pain. They can occur due to normal wear and tear, inflammation, and trauma. They are often seen in people involved in certain sports or jobs that require moving their arms in a certain way over and over. Examples are basketball, tennis, and painting.
Causes of Condition
Below is a list of rotator cuff disorders and their causes:
Calcific tendonitis - This develops due to the build-up of calcium deposits. It can restrict the arm’s range of motion. It also often results in pain and discomfort. The condition is more common in patients aged between 30 and 40. It often resolves without treatment within two to four weeks.
Rotator cuff tendonitis - This means that the rotator cuff is inflamed. This condition is often seen in people who are involved in activities that require lifting their arms above the head over and over.
Bursitis - This refers to a swollen bursa. The bursa is a sac located between the bone on top of the shoulder and the rotator cuff. It contains lubricating fluid. It is responsible for making sure that the rotator cuff tendons are able to glide smoothly when the arm is moved. Bursitis is often caused by repeated minor trauma to the shoulder joint. It can also be caused by infection.
Rotator cuff tears - A torn rotator cuff is one of the common causes of shoulder weakness. It can make simple activities very painful. Patients with this condition often find it difficult to comb their hair or put their seatbelt on. The tear can be full or partial. It is the latter if the tendon is damaged but remains attached to the bone. It is the former if the tendon separates from the bone. Both types can be caused by bone degeneration. They can also occur due to trauma. An example is when a person falls on an outstretched arm or lifts something that is too heavy.
The first sign of the condition is severe pain. The pain often starts on the side and front areas of the shoulder. It can prevent patients from lifting their arms away from their body. In patients with full rotator cuff tears, holding the arm up is often not possible. In severe cases, shoulder pain can be felt even when patients are at rest. Such symptoms can make them lose sleep. Other common signs are reduced range of motion and shoulder weakness. These can prevent a person from lifting objects and holding their arms straight.
The disorders should be treated right away. If the shoulder remains immobile for an extended period, patients may develop a condition called frozen shoulder syndrome.
Who to See and Types of Treatments Available
Patients with disorders of the rotator cuff must see an orthopaedic specialist. These doctors specialise in the treatment of disorders that affect the bones and muscles. Tests to diagnose the condition include:
A physical exam - The doctor will check the shoulder area to look for signs of injuries. During the test, the patient is asked to perform different arm movements. They will be asked to try to lift their arms overhead. If possible, they may also be asked to hold their arms straight. Doctors will also look for physical signs of the injury. These include inflammation and tenderness in the shoulder area. This helps assess the severity of the condition.
Review of patient’s medical history - Doctors would want to know if patients have a history of certain medical conditions, such as diabetes. Patients are also asked about the nature of their jobs and if they are involved in certain types of sports.
Imaging tests - Doctors often use x-rays to get images of the damaged area. An MRI can also be used. This provides more detailed information than x-rays. By combining the results of these tests, doctors are able to diagnose the condition and determine its severity.
Mild to moderate cases are often managed with nonsurgical treatment. The goals are to treat pain and increase shoulder function. Patients are given painkillers and anti-inflammatory medications. They are also advised to use cold packs and avoid activities that can cause further damage to the joint. In many cases, the injuries respond well to nonsurgical treatments. Patients are able to go back to their daily routine within two to four weeks.
Severe cases may require surgery. Examples are when the rotator cuff is completely torn or when the patient has a frozen shoulder. Surgery may involve stitching together the torn edges of the rotator cuff. It is then reattached to the humerus bone. It may also be necessary to remove loose fragments to improve treatment outcomes. These fragments may include inflamed sections of the bursa and bone spurs. In cases where the rotator cuff is compressed, the surgeon will also have to shave the bones around it.
The surgery can be done using the traditional method. In this procedure, the surgeon creates a long incision in the shoulder area. A better alternative is called arthroscopic repair. It is less invasive and requires only small incisions. It is known to reduce the many risks of surgery, such as bleeding and infection. Surgeons choose the best method to use based on the nature of the injury and its severity.
Surgery is often followed by physical therapy. Working with a physical therapist, patients are able to restore the strength of their shoulder faster. This allows them to get back to their normal activities sooner.
Kasper, D.L., et al., eds. Harrison’s Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.
Frontera WR, et al. Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation. 2nd ed. Philadelphia, Pa.: Saunders Elsevier.