What is Rotator Cuff?
In the simplest of terms, the rotator cuff is a group of four muscles and their tendons that help to stabilize and move the shoulder joint. The shoulder is basically a ball-and-socket joint. Unlike most ball and socket joints, however, the shoulder is not naturally stable. The “ball” of the shoulder is much larger than the socket so the shoulder does easily stay in the center of the joint. The rotator cuff, a network of muscles that surrounds the shoulder, helps to keep the ball and socket properly aligned. In addition to this, the rotator cuff helps you lift and rotate your arm in numerous directions.
The rotator cuff muscles are small but they are very strong for their size and have great endurance, allowing them to contract and do their job repeatedly and for long periods of time. These muscles are essential for doing things that involve your arms and especially those that require you to have your arms over your head. These activities include everything from throwing a ball, to changing a light bulb, to blow-drying your hair. With age or injury, the rotator cuff can become inflamed or damaged. By doing repetitive motions on the job or playing sports, the risk of injury increases.
The most common symptom of a rotator cuff problem is pain in the shoulder or upper arm. Most people will localize it to the area directly lateral to the shoulder over the deltoid muscle. Pain can occur and intensify suddenly in certain situations, such as if one falls on their shoulder or lifts something too heavy. Other times pain can arrive more gradually, over a period of weeks or months.
Some people can give no real starting point for their pain, saying that they just woke up with it one morning. If the rotator cuff is torn then people usually also experience weakness due to the muscle/tendon no longer being able to do its job. People can have a partial tear or a full-thickness tear (also called a complete tear) of their rotator cuff, and, again, either can happen as a result of an injury or from repeated use. Regardless of how a rotator cuff injury happens, the symptoms of pain or weakness in the arm and affected shoulder may impact a person’s daily routine.
When the rotator cuff is painful or injured, an examination by a physician will be necessary to determine the extent of the damage. The doctor will measure the shoulder’s range of motion, test arm strength, and determine if the problem is the rotator cuff, the shoulder joint, the neck or another medical condition. Imaging tests such as x-rays or MRI may also be used to help confirm the diagnosis is indeed a rotator cuff tear.
Several treatment options are available for a rotator cuff tear, including nonsurgical and surgical methods. For partial tears of the rotator cuff, we are often able to treat the patient conservatively with medication and therapy. Occasionally an injection of steroid into the shoulder is used if the pain and inflammation are severe and do not respond to oral medication. Unfortunately, when a complete rotator cuff tear occurs, it is almost always necessary to repair it surgically to guarantee normal recovery of function. The best treatment method is different for every person. Your doctor will discuss with you the best treatment option for your specific situation. Sometimes, if the pain does not improve with nonsurgical methods, surgery may be recommended to repair a torn rotator cuff whether the tear is complete or partial in nature. Depending on your individual health needs, your orthopaedic surgeon will also discuss with you the best procedure for your condition.
Surgery is necessary with complete rotator cuff tears because the tendon is fairly elastic. When the rotator cuff tear occurs, the tendon retracts away from the bone, creating a gap between the tendon and the bone that prevents the body from being able to heal the tear. The surgical procedure that is done reattaches the tendon, putting it back on the bone so that healing can occur. At the same time, any bone spurs around the shoulder are removed and any arthritis is also treated. We are now able to do these previously large procedures arthroscopically, using a small camera through miniature incisions. Large incisions that damage the muscles around the shoulder and create more pain and stiffness are no longer necessary. As a result of this, most surgical treatment options for rotator cuff tears no longer require an overnight stay in a hospital.
After surgery the tendon healing requires about 6 weeks. During that period, we must protect the rotator cuff to allow normal healing to occur. We do that by immobilizing or limiting use of the arm after surgery. Depending on the size of your tear, you may have to keep your arm from moving for several weeks before the orthopaedic surgeon decides that it is safe for you to begin range of motion exercises. While we would ideally prevent all shoulder motion to allow healing, stiffness can result if immobilization is continued for too long. To prevent this, a simple “passive” exercise program is usually given to the patient at some point during that first six weeks, unless the tear is very large. Whichever technique is used, healing the damaged tendon is the primary goal.
After the tendon is healed, rehabilitation will become the next vital step. Regaining motion and shoulder strength will take time. A physical therapy program will progress over the weeks after surgery to help the function return. A therapist will work with you in completing your exercises that are focused on increasing range of motion and strength in your shoulder. Active range of motion and strengthening are usually started after the six weeks of healing are completed. Patients actively continue with the therapy program, and over time, see increased strength and range of motion. Complete recovery time can vary from 3-6 months after surgery, with some patients reporting improvement for up to a year after surgery.
Remember, improved shoulder strength and pain relief are the healing goals for repairing a torn rotator cuff. Your orthopaedic surgeon will discuss with you all individual treatment options that may best suit your situation.