The rotator cuff is a group of four muscles connecting the shoulder blade to the arm bone, the humerus. They function as a group to stabilize the shoulder joint and assist in lifting and rotation of the arm. When injured, patients will often notice pain, weakness, and often mechanical complaints like grinding or catching of the joint, especially with overhead activities.
Rotator cuff injuries can affect patients of any age. Typically in patients younger than 40 years old, the tissue is rarely torn and more often suffers from conditions such as impingement, bursitis, or tendonitis. In these situations, the structure of the rotator cuff is often sound, however weakness in the shoulder blade, inflammation in the surrounding bursa, or early changes in the quality of the rotator cuff tendon are the source of pain.
Because of this, rotator cuff conditions in this age group can often be managed conservatively through combinations of medications, injections, and physical therapy.
In older patients or younger ones suffering from significant injuries sometimes seen in falls and at work, the rotator cuff tissue can begin to tear. When this occurs, pain can become more constant. It will often be felt on the top or front of the shoulder. It can radiate to the upper arm as well. Pain shooting to the hand is less often caused by rotator cuff tears and more so by issues affecting the spine. Pain often manifests worse at night. In these situations, in addition to a thorough physical exam and x-rays, patients will often undergo an MRI. Shoulder injuries are easier to see when there is fluid within the joint, so your physician will often order an arthrogram, whereby a special dye is injected into the joint, just prior to the MRI.
Even if an MRI shows a full thickness tear, there can be some benefit seen with further conservative treatment such as physical therapy, even though the tear will unlikely heal in this situation. However, in patients suffering persistent pain and weakness, or when there is a fear that the tear will enlarge over time, surgery is often recommended. Traditional open and arthroscopic options exist to fix the torn tendon to the bone. The small incisions and lower blood loss of arthroscopic surgery offers the chance to have decreased pain, less stiffness, and a faster recovery. Healing rates are likely similar between the two options.
After surgery most repairs will require the use of a sling for 4-6 weeks. Complete healing of repairs can take three months, and full recover is often anywhere from 4-6 months. Physical therapy and home exercise play a key role in preventing stiffness and regaining strength in the shoulder muscles.
As you can see, rotator cuff tears present multiple options in their treatment. It is important to talk to your physician about which is the best treatment for your situation.
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