The rotator cuff is the group of four muscles and tendons that surround the shoulder joint, providing strength and stability. Above the rotator cuff there is a bursa, or sac of tissue, that covers and protects the rotator cuff as it comes into close contact with bones around the shoulder (Figure 1). When the rotator cuff is injured or damaged, it can lead to inflammation of the bursa, called bursitis, which causes pain and loss of motion.
While some rotator cuff injuries occur as a result of an accident, most result from aging and deterioration of the cuff. Rotator cuff tears increase in incidence with age.
A rotator cuff injury can vary from microscopic tears to large irreparable tears. Symptoms can include:
The symptoms are usually worse in certain positions, such as reaching backward to fasten a seat belt or pick up a briefcase out of the back seat. Symptoms can also be worse when the arm is elevated overhead, especially if there is weight on the arm, such as when picking up a stack of plates out of a cupboard. Overhead activities like pitching, throwing, playing tennis or playing racquet-ball commonly worsen symptoms.
But not all rotator cuff tears are painful, and many individuals with rotator cuff injuries have no symptoms.
The diagnosis can come from:
Injections or arthroscopy may also be used to help diagnose rotator cuff tears.
Common treatment options may include:
If these treatments fail, surgical intervention (Figure 3) such as arthroscopy is a reasonable option. Large tears may require joint replacementsurgery.
Postoperative treatment depends on which surgical procedure was chosen, but therapy is a critical part of the recovery. Therapy can last from three to 12 months. A coordinated effort between the patient, surgeon and physical or occupational therapist is required.
© 2014 American Society for Surgery of the Hand
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