Rotator Cuff Injuries

What is the rotator cuff

The rotator cuff is a network of four muscles and several tendons that cover the humeral head. The rotator cuff holds the humeral head in the joint and allows the arm to rotate. The four cuff muscles (supraspinatus, infraspinatus, subscapularis and teres minor) originate on the scapula and insert onto the front and outer part of the humeral head, on the greater tuberosity.

Causes of rotator cuff injuries

The rotator cuff can tear as a result of a single traumatic injury. The most common tears, however, result from excessive strain on this group of muscles over a period of years. Patients at increased risk are those who perform repetitive overhead movements. This includes athletes who play tennis, baseball and rowing, as well as weightlifters.

Rotator cuff tears are most frequently seen in patients over 40. Younger patients develop rotator cuff injuries following trauma or as a result of overhead overuse of the arms.

Symptoms of a rotator cuff injury

The symptoms of rotator cuff injuries include:

• Wasting of the muscles around the shoulder
• Pain when raising the arm
• Pain when lowering the arm after raising it fully
• Weakness when lifting and rotating the arm
• Crepitus or clicking in certain positions

Pain at the front of the shoulder radiates into the outer part of the arm and may at first be mild, appearing only during demanding activities. Over time the pain increases in intensity, including at rest, and may appear when weight presses on the affected area — for example during the night.

Conservative treatment of a rotator cuff injury

In many cases, conservative treatment can reduce the pain and improve shoulder function. Conservative treatment options include:

• Rest and limiting demanding activities (no overhead movements)
• Using a sling
• Anti-inflammatory medication
• Cortisone injections — these may be recommended when the pain persists even after other anti-inflammatory medication has been used
• Muscle strengthening exercises and physiotherapy — carried out with a physiotherapist; initially focused on reducing pain and inflammation. Treatments may include the use of heat or ice, as well as ultrasound.

Surgical treatment of a rotator cuff injury

The orthopaedic surgeon may recommend surgery if:

• Conservative treatment does not relieve the symptoms
• The tear is acute and very painful
• The tear is in the shoulder of the dominant arm and the person is active
• The patient does physical work or competitive sport

The type of operation performed depends on the size, shape and location of the tear. A partial tear may require only a smoothing procedure, known as debridement. A complete tear is repaired by suturing the two parts of the torn tendon together.

There are several ways of repairing rotator cuff injuries:

• Arthroscopic repair — used in most cases. The arthroscope is a special camera that can be inserted into the shoulder joint through a small incision in the skin.
• Transosseous suture — uses sutures passed through bone to reattach the torn tendons
• Anchor reattachment — uses transosseous anchors to secure the torn tendons
• Open repair — usually necessary for large or complex tears, or if additional reconstructive procedures are required.