Injuries to the rotator cuff occur in a spectrum ranging from mild inflammation to complete destruction of the shoulder. Pain can be present in the shoulder with any of the conditions. The range of motion of the shoulder may be decreased in any of the conditions, however, the more destruction to the shoulder joint, the less range of motion there typically will be. Treatments are usually non-operative initially, but some conditions require surgery.
Anatomy
The rotator cuff is composed of four separate muscles that form a common tendon. These muscles are the supraspinatus, infraspinatus, teres minor and subscapularis. These muscles allow the shoulder to move in all different planes. The supraspinatus muscle is the most commonly injured muscle/tendon in rotator cuff injuries.
Impingement Syndrome
Impingement syndrome occurs when there is microtrauma to the rotator cuff due to decreased space between the humeral head and structures above the rotator cuff. The trauma to the rotator cuff causes inflammation, swelling, pain and poor function of the shoulder. Overhead activities such as throwing, golf, tennis and swimming may exacerbate the condition. Treatment is usually rest from the overhead activities, physical therapy and anti-inflammatories. Surgery is performed if non-operative treatments fail to relieve symptoms.
Rotator Cuff Tendinitis
Rotator cuff tendinitis is a condition of overuse associated with irritation and swelling of the cuff tendons, most commonly the supraspinatus. Rotator cuff tendinitis can result from impingement syndrome or from shoulder instability. Patients report pain with moving the shoulder. The range of motion of the shoulder is decreased by pain. This pain may also wake the patient up at night. Treatment is aimed at rest from activities that cause pain, doing physical therapy to strengthen the muscles, icing the shoulder, and taking anti-inflammatories. A physician may inject a steroid to help alleviate symptoms and decrease inflammation.
Rotator Cuff Tears
According to the "AAOS Comprehensive Orthopaedic Review," the incidence and prevalence of rotator cuff tears increase with age, with approximately 51 percent of patients over age 80 having asymptomatic rotator cuff tears. Rotator cuff tears can be either partial or complete tears. Often they occur with no history of trauma. Pain is typically at night, with overhead activities, and when reaching behind the back. The tear can be acute if under three months of pain have been experienced, chronic if the pain has been for more than three months, or acute on chronic if there has been an enlargement of a tear.
Treatment can be nonsurgical or surgical. Nonsurgical treatment is aimed at avoiding certain activities that cause pain, icing the joint, anti-inflammatory medications, physical therapy, and/or steroid injections. Older patients may do very well with nonsurgical treatment.
Surgical treatment is indicated for individuals under age 60 with acute tears and those that fail nonsurgical treatment. The surgery can be performed with larger incisions known as an open rotator cuff repair or arthroscopically using small incisions and a camera to repair the torn rotator cuff.
Rotator Cuff Tear Arthropathy
Rotator cuff tear arthropathy refers to a condition of shoulder arthritis with a rotator cuff tear. Cuff tear arthropathy typically involves a large chronic rotator cuff tear, osteoporotic or decreased bone mineral density, cartilage loss, and collapse of the humeral head or ball portion of the joint. Patients typically have pain, decreased shoulder range of motion, and significant damage to the joint seen on an X-ray with arthritic changes.
Treatment is initially nonsurgical with physical therapy, anti-inflammatories, steroid injections and activity modification. Surgery may be indicated and this may involve arthroscopically cleaning up the joint or some type of shoulder replacement procedure--either replacement of the ball or the entire ball and socket of the shoulder joint. Patients may need to see an orthopaedic shoulder specialist to evaluate the best joint replacement type for the patient's condition.
References
- "The Sports Medicine Patient Advisor (2nd edition)"; Dr. Pierre Rouzier; 2004.
- "Expert Guide to Sport Medicine"; Dr. Matthew Davis, Dr Peter Davis, and Dr David Ross (eds); 2005.
- "AAOS Comprehensive Orthopaedic Review"; Dr. Jay Lieberman; 2008.
- Wheeless' Textbook of Orthopaedics: Anatomy of Rotator Cuff
