The rotator cuff is a group of muscles and tendons that lift and rotate the arm, and injuries to these muscles and tendons are a common cause of shoulder pain, according to the American Academy of Orthopaedic Surgeons. Tendons are strong, cord-like connective tissues that attach muscles to bone. Tendonitis is inflammation of a tendon, which can result from repetitive overhead activities, age-related wear, and rotator cuff tears.
Anatomy
The rotator cuff is composed of four muscles and the tendons that connect these muscles to three shoulder bones. In addition to the tendons, the American Academy of Orthopaedic Surgeons, or AAOS, says there are two tendons, called the long head and short head of biceps tendon, that attach the biceps muscle to the shoulder socket and shoulder blade.
Symptoms
Tendonitis of the long or short head of biceps tendon causes a dull pain in front of the shoulder that extends down the upper arm. According to eOrthopod, tendonitis associated with a rotator cuff tear is more localized to the shoulder and might include a dull sensation of tissues binding or catching with movement.
Causes
According to the AAOS, there are internal and external causes of rotator cuff tears, both of which can result from aging. Internal causes include reduced blood supply to the tendons and age-degeneration of the tissue. External causes include bone spurs that develop over time. If the spur rubs on a tendon, the tissue becomes inflamed, causing pain, called tendonitis. According to eOrthopod, the combination of low blood supply and chronic inflammation can weaken the tendon so that excessive force from lifting, falling or repetitive motion causes the tendon to tear.
Diagnosis
The doctor will conduct a physical examination observing the range of motion and the degree of pain with motion. With a partial tear, the pain increases as the arm is raised, and can severely limit the range of motion. If the doctor is able to move the arm through a complete range of motion but the patient is unable to move the arm, it usually indicates a full-thickness tear. An imaging study using X-rays, magnetic resonance imaging or ultrasound usually follows the physical exam.
Nonsurgical Treatment
According to the AAOS, non-surgical treatment for rotator cuff tears involves modifying activity to avoid work or sports linked to the tear and to control pain and inflammation. Medication also might be given to further reduce inflammation. Often the doctor will refer the patient to a physical or occupational therapist to help increase the range of motion and strengthen the uninjured muscles to compensate for the injured tendon.
Surgical Treatment
If the nonsurgical treatment does not help, or the tear cannot be treated non-surgically, the doctor might recommend surgery to sew the torn segments of tendon together, if possible. If not, the surgeon might graft tissue from some other part of the body to repair the tendon. There are three types of surgery to repair rotator cuff tears: Open surgery uses a 2- to 3-inch incision in the shoulder, mini-open surgery uses a series of smaller incisions, and arthroscopic repairs use multiple small incisions and image-guided instruments to make the repairs.
Rehabilitation
After recovering from surgery, most patients will require a sling for four to six weeks, after which rehabilitation with the help of a physical or occupational therapist will be needed to strengthen the shoulder and return it to a functional range of motion.
