Rotator cuff injuries and treatments
The rotator cuff consists of tendons from four corresponding muscles in the shoulder. These tendons attach to the upper humerus (upper arm bone) and form a cuff of tissue that surrounds the ball or head of the humerus. This cuff stabilizes the ball-and-socket joint in motion, allowing you to lift your arm and rotate your shoulder.
Rotator cuff syndrome is a broad term that covers a wide range of rotator cuff injuries and conditions, including:
- Acute strains.
- Chronic irritation of the tendon (tendonitis).
- Impingement or irritation around the joint.
- Partial or full thickness rotator cuff tendon tears. A rotator cuff tear occurs when any portion of the cuff is disrupted.
Rotator cuff syndrome can develop suddenly as a result of a specific injury or traumatic event, or it may develop gradually due to progressive degeneration or wear and tear. Activities that require a lot of repetitive overhead movement — such as painting and yard work as well as sports like baseball, tennis, golf and pickleball — can increase your risk for a rotator cuff injury. That risk further increases as you age.
Symptoms of rotator cuff syndrome often present gradually. You may experience pain on the outside or front of the shoulder. The pain can also radiate down toward the elbow and may worsen at night. You also may experience weakness when reaching overhead or when trying to lift something heavy. The inability to raise your arm and loss of motion may signal a rotator cuff tear. When any of these symptoms occur and are persistent, you should seek medical attention.
Treatment for rotator cuff injuries
Treatment for rotator cuff syndrome includes both nonsurgical and surgical options. Conservative treatment is often recommended first and consists of rest, pain-relieving methods, therapy and exercise, and potential steroid injections. When conservative options fail, or there's significant structural damage to the shoulder, surgical options may be needed to repair or replace damaged tendons. Occasionally, shoulder replacement surgery may be recommended. Regardless of the treatment, the goal is to decrease pain and restore shoulder function. Your orthopedic surgeon will determine the best course of action based on your individual symptoms and the severity of your injury.
Rotator cuff repair surgery
Rotator cuff repair is often recommended for acute rotator cuff tears as well as for chronic tears when conservative management is unsuccessful or there are significant functional deficits resulting from the tear. Repairs are performed using open and arthroscopic techniques. Some of the procedures that may be performed during surgery include:
- Rotator cuff repair: Reattaching healthy cuff tissue back to the humerus (upper arm bone) using anchors and/or sutures (stitches).
- Subacromial decompression: Removing a spur from the undersurface of the roof of the shoulder (acromion). If present, these spurs can rub or impinge on the rotator cuff leading to pain, inflammation, and tearing.
- Arthroscopic or open debridement: Removing loose or frayed bone, tendon, ligament, and other debris in the shoulder joint. Essentially cleaning out the shoulder.
- Biceps tenodesis: Reattaching the biceps tendon outside of the shoulder joint. Occasionally the biceps tendon, which attaches inside the shoulder joint at the top of the socket, can be torn or inflamed, leading to pain and dysfunction. In these cases the biceps will be detached from inside the joint and reattached outside of the joint, improving pain and function.
Recovery after rotator cuff repair
After surgery, your arm will be immobilized in a sling for three to six weeks, depending on the procedure. During this initial phase, you'll be asked to do some light shoulder, elbow and hand exercises at home, as directed by your surgeon. Generally, you'll be advised to avoid any weight-bearing activity with that arm.
Physical therapy will be started by your surgeon when appropriate, usually at three to six weeks after surgery. You'll also continue doing home exercises to slowly increase your range of motion and strength. Your individual recovery and rehabilitation plan will be based on:
- The extent of your rotator cuff tear.
- The health of your tendon.
- Your overall health.
You'll gradually experience pain relief and start seeing noticeable improvements in strength and function. Most patients can return to normal activities of daily living at about three to four months after rotator cuff repair surgery. You should expect to see continued improvement for up to a year after surgery.