Rotator cuff is a group of four muscles located in the shoulder. They are very important for day to day activities which involves the shoulder. The shoulder is a ball and socket type of joint. The rotator cuff attaches to the ball component (humerus) of the shoulder joint. Injury or damage to the rotator cuff could be the reason why many people experience pain in the shoulder. The pain due to rotator cuff tear is normally felt on the top or outside of the shoulder. It is also very common to experience pain anywhere between the shoulder and elbow along the outer aspect. The pain typically occurs after the use of shoulder and is often quite significant at night, disturbing your sleep.
There are a number of ways a rotator cuff can be injured. A fall on the outstretched arm or a fall onto the shoulder can cause a rotator cuff injury. More commonly, a rotator cuff tears over a period of time due to degenerative changes within the tendon. People can develop arthritic changes in the joint above the shoulder (acromio-clavicular joint) at the far end of the collar bone (clavicle). When this joint becomes arthritic, spurs can protrude downwards, which can cause injury to the tendon. Other ways a rotator cuff can tear is due to overuse. This type of tears is usually seen in the athletic population who play sports like swimming, weightlifting and throwing.
Besides the pain, feeling of weakness in the arm can be an additional symptom. The weakness is typically experienced while doing an activity wherein the arm is held away from the body. If you are suffering from any of these symptoms, its advisable to see a specialist Orthopaedic surgeon.
The orthopaedic surgeon performs a through physical examination of your shoulder. If a rotator cuff tear is suspected he may request for several investigations to confirm the diagnosis. A radiograph (xray) of the shoulder will be helpful to look for the presence of spurs and arthritis of the acromio-clavicular joint. MRI scan is a simple, non-invasive test to confirm the diagnosis of rotator cuff tear. The advantage of MRI is that it does not involve radiation exposure and it can pick up a rotator cuff tear most of the times. It clearly demonstrates the type and size of the tear and the quality of the rotator cuff tendon.
Treatment of rotator cuff tear initially includes pain medications, cold compresses and gentle exercise programmes. It is advisable to decrease the amount of overhead lifting for a few weeks. Your surgeon may offer an injection of cortisone. Cortisone helps to relieve pain by reducing the inflammation. If the pain persists or recurs after resuming normal activities, you may be a candidate for surgery.
Over the past few years, arthroscopy (key hole joint surgery) has been used to repair the torn rotator cuff. This is much less invasive way to adress the rotator cuff tear. The arthroscopic surgery involves 3-4 small incisions around the shoulder. The camera and surgical instruments are inserted through these incisions and the rotator cuff tear can be repaired. The advantage of arthroscopic surgery is less pain, minimal blood loss and quicker recovery. There is very minimal damage to the sorrounding structures and it avoids unsightedly scars. With the advent of arthroscopy, rotator cuff can be performed as a day care procedure. Following the surgery, a period of rehabilitation follows for several weeks, before you can resume your full set of activities like lifting heavy weight.
One of the problems with these tears is when the pain has been neglected for a long time. If the rotator cuff has been left torn for several months or years, they can slowly progress in size and become irrepairable. It may lead to progressive arthritis of the shoulder (rotator cuff tear arthropathy). These conditions can cause persistant pain and weakness and may need complicated procedures to be addressed.